Healthcare Provider Details

I. General information

NPI: 1184230898
Provider Name (Legal Business Name): EVELYN MICHELLE RAINEY DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SPILLWAY RD
BRANDON MS
39047-6066
US

IV. Provider business mailing address

402 ASBURY LANE DR
BRANDON MS
39042-2129
US

V. Phone/Fax

Practice location:
  • Phone: 601-992-5532
  • Fax: 601-992-5547
Mailing address:
  • Phone: 662-809-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904160
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: