Healthcare Provider Details

I. General information

NPI: 1265661656
Provider Name (Legal Business Name): DAVID BROCK RAINS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 OAK RIDGE TPKE
OAK RIDGE TN
37830-6976
US

IV. Provider business mailing address

7900 CORBIN LN
KNOXVILLE TN
37931-1788
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-1000
  • Fax:
Mailing address:
  • Phone: 865-755-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146017
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14442
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: