Provider Demographics
NPI:1417568585
Name:SCOTT, RAINEE DAVIS (APRN)
Entity Type:Individual
Prefix:
First Name:RAINEE
Middle Name:DAVIS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RAINEE
Other - Middle Name:NICOLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6738 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63736-8238
Mailing Address - Country:US
Mailing Address - Phone:573-313-2500
Mailing Address - Fax:
Practice Address - Street 1:200 PINE ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-3258
Practice Address - Country:US
Practice Address - Phone:573-313-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020018323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily