Provider Demographics
NPI:1659620862
Name:RAINES, TRACI L (APRN, FPMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:RAINES
Suffix:
Gender:F
Credentials:APRN, FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 13TH STREET SOUTH
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-731-8865
Mailing Address - Fax:406-731-8874
Practice Address - Street 1:2800 13TH STREET SOUTH
Practice Address - Street 2:SUITE 6
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-731-8865
Practice Address - Fax:406-731-8874
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT33133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000371690OtherBLUE CROSS-SHIELD OF MONTANA
MT0000371690OtherBLUE CROSS-SHIELD OF MONTANA