Provider Demographics
NPI:1114297249
Name:RAINES, KELLEY R (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:R
Last Name:RAINES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 MILLERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7230
Mailing Address - Country:US
Mailing Address - Phone:937-205-7935
Mailing Address - Fax:
Practice Address - Street 1:7321 MILLERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7230
Practice Address - Country:US
Practice Address - Phone:937-205-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse