Healthcare Provider Details

I. General information

NPI: 1831742659
Provider Name (Legal Business Name): RACHEL MARIE RAINEY MSN, APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1598 W MEYER RD
WENTZVILLE MO
63385-3653
US

IV. Provider business mailing address

3221 MCKELVEY RD STE 301
BRIDGETON MO
63044-2551
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-8228
  • Fax:
Mailing address:
  • Phone: 636-498-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07191407
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: