Provider Demographics
NPI:1407402795
Name:DANIELS, MARTHA RAINEY (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA RAINEY
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:RAINEY
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 HIGHLEADON CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7465
Mailing Address - Country:US
Mailing Address - Phone:601-573-3635
Mailing Address - Fax:
Practice Address - Street 1:509 HIGHLEADON CV
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7465
Practice Address - Country:US
Practice Address - Phone:601-573-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903450363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health