Provider Demographics
NPI:1689235798
Name:RAINEY, MELISSA SUE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1525
Mailing Address - Country:US
Mailing Address - Phone:304-720-2345
Mailing Address - Fax:304-720-2347
Practice Address - Street 1:3701 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1525
Practice Address - Country:US
Practice Address - Phone:304-720-2345
Practice Address - Fax:304-720-2347
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN103648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAPRN103648OtherLICENSE