Healthcare Provider Details

I. General information

NPI: 1891625695
Provider Name (Legal Business Name): KIARA VICTORIA RAINEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON AVE
COVINGTON KY
41011-3313
US

IV. Provider business mailing address

11514 MAPLE BROOK DR APT 105
LOUISVILLE KY
40241-3062
US

V. Phone/Fax

Practice location:
  • Phone: 850-655-6100
  • Fax:
Mailing address:
  • Phone: 850-655-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-00207
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: