Provider Demographics
NPI:1245328947
Name:RAINES, RONNIE (NP)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:RAINES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551
Mailing Address - Country:US
Mailing Address - Phone:931-243-3581
Mailing Address - Fax:
Practice Address - Street 1:100 OLD JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551
Practice Address - Country:US
Practice Address - Phone:931-243-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010958363L00000X
TN12318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4136449OtherBCBS
TN4136449OtherBCBS