Healthcare Provider Details

I. General information

NPI: 1588693634
Provider Name (Legal Business Name): KATHERINE M RAINES APMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MANN

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET DEPARTMENT OF PSYCHIATRY AND HUMAN BEHAVIOR
JACKSON MS
39216-4505
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-814-5815
  • Fax:
Mailing address:
  • Phone: 601-984-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR851180
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR851180
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR851180
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: