Provider Demographics
NPI:1235752536
Name:RAINEY, TARA (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:RAINEY
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 E 4800 S STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5041
Mailing Address - Country:US
Mailing Address - Phone:801-264-9522
Mailing Address - Fax:801-265-9604
Practice Address - Street 1:845 E 4800 S STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5041
Practice Address - Country:US
Practice Address - Phone:801-264-9522
Practice Address - Fax:801-265-9604
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7307565-3102163W00000X
390200000X
UT7307565-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program