Healthcare Provider Details

I. General information

NPI: 1093016081
Provider Name (Legal Business Name): AMIE SIMS RAINEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3062 MAIN ST
PIKEVILLE TN
37367-5746
US

IV. Provider business mailing address

PO BOX 349 3062 MAIN STREET
PIKEVILLE TN
37367-0349
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2955
  • Fax: 423-447-2405
Mailing address:
  • Phone: 423-447-2955
  • Fax: 423-447-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN0000103481
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015214
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: