Provider Demographics
NPI:1184230898
Name:RAINEY, EVELYN MICHELLE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:MICHELLE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 ASBURY LANE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2129
Mailing Address - Country:US
Mailing Address - Phone:662-809-3009
Mailing Address - Fax:
Practice Address - Street 1:1887 SPILLWAY RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6066
Practice Address - Country:US
Practice Address - Phone:601-992-5532
Practice Address - Fax:601-992-5547
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily