Healthcare Provider Details

I. General information

NPI: 1962122044
Provider Name (Legal Business Name): CATHERINE RAINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11021 CHAPMAN HWY
SEYMOUR TN
37865-4808
US

IV. Provider business mailing address

7222 BROKEN CREEK LN
KNOXVILLE TN
37920-7589
US

V. Phone/Fax

Practice location:
  • Phone: 865-205-3028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number31882
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: