Healthcare Provider Details

I. General information

NPI: 1669257341
Provider Name (Legal Business Name): MEKHLA B RAINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280A MAIN ST
ALTAVISTA VA
24517-1465
US

IV. Provider business mailing address

336 BEVERLY HILLS CIR
LYNCHBURG VA
24502-4106
US

V. Phone/Fax

Practice location:
  • Phone: 434-309-1165
  • Fax:
Mailing address:
  • Phone: 757-529-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024187981
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: