Healthcare Provider Details

I. General information

NPI: 1295658383
Provider Name (Legal Business Name): CHRISTOPHER TYLER RAINWATER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S 3RD ST
DANVILLE KY
40422-1823
US

IV. Provider business mailing address

217 S 3RD ST
DANVILLE KY
40422-1823
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-2030
  • Fax:
Mailing address:
  • Phone: 859-239-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTSA023
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: