Provider Demographics
NPI:1083950760
Name:RAINEY, TRACEE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:TRACEE
Middle Name:
Last Name:RAINEY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 SOUTHWESTERN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:MAIL ROUTE MN 008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:469-992-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724171363LA2200X
TXAP122940363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01237942OtherRAILROAD PTAN
TX2035487-03OtherGROUP TPI
TXD07564OtherRAILROAD GROUP
TX314177YNEAOtherMEDICARE PTAN
TX8865NAOtherBCBS
TX323183-01OtherMEDICAID TPI
TX3232183-01OtherIND TPI
TX323183-01OtherMEDICAID TPI