Provider Demographics
NPI:1699859025
Name:RAINEY, KAREN K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:K
Last Name:RAINEY
Suffix:
Gender:F
Credentials:PA-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 207
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-0207
Mailing Address - Country:US
Mailing Address - Phone:304-894-8211
Mailing Address - Fax:304-894-8213
Practice Address - Street 1:2401 S KANAWHA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6967
Practice Address - Country:US
Practice Address - Phone:304-894-8211
Practice Address - Fax:304-894-8213
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00531363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001719157OtherBCBS INDIVIDUAL
WV001719157OtherBCBS INDIVIDUAL
WVS81127Medicare UPIN