Healthcare Provider Details

I. General information

NPI: 1942319728
Provider Name (Legal Business Name): KATHERINE M. RAINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18614 JACKSON ST
HERMITAGE MO
65668
US

IV. Provider business mailing address

PO BOX 125
HERMITAGE MO
65668-0125
US

V. Phone/Fax

Practice location:
  • Phone: 417-745-2121
  • Fax: 417-745-6141
Mailing address:
  • Phone: 417-745-2121
  • Fax: 417-745-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number140799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: