=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588147656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAYNE FAMILY HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2018
-----------------------------------------------------
Last Update Date | 10/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 THE BLVD STE C
-----------------------------------------------------
City | RAYNE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70578-6135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-779-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 S 5TH ST
-----------------------------------------------------
City | IOTA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70543-6105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-779-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | NICOLE DOUCET
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 337-275-6915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------