Healthcare Provider Details

I. General information

NPI: 1164242822
Provider Name (Legal Business Name): RAINNA RENE BARNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11102 LINDBERGH BUSINESS CT
SAINT LOUIS MO
63123-7810
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 573-366-0851
  • Fax: 314-206-3477
Mailing address:
  • Phone: 314-206-3700
  • Fax: 314-206-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2014039583
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: