Healthcare Provider Details

I. General information

NPI: 1831714096
Provider Name (Legal Business Name): JO ANNE RAINEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 06/13/2020
Certification Date: 06/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 LARCH LN
LEXINGTON KY
40511-2006
US

IV. Provider business mailing address

233 LARCH LN
LEXINGTON KY
40511-2006
US

V. Phone/Fax

Practice location:
  • Phone: 859-608-3154
  • Fax:
Mailing address:
  • Phone: 859-608-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1191
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1191
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1191
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1191
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: