Provider Demographics
NPI:1407363146
Name:RAINER, TYSON SCOTT (FNP-C)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:SCOTT
Last Name:RAINER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2420
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-2420
Mailing Address - Country:US
Mailing Address - Phone:256-638-8513
Mailing Address - Fax:256-638-8533
Practice Address - Street 1:124 MCCURDY AVE S STE C
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5206
Practice Address - Country:US
Practice Address - Phone:256-638-8513
Practice Address - Fax:256-638-8533
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF01180190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily