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General NPI Number Information
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NPI Number | 1689235798
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Entity Type | Individual
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Provider Name | MELISSA SUE RAINEY APRN, FNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 3701 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1525
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Country | US
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Telephone | 304-720-2345
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Fax | 304-720-2347
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Provider Business Mailing Address
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Address Line | 3701 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1525
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Country | US
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Telephone | 304-720-2345
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Fax | 304-720-2347
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN103648
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License Number State | WV
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