Provider Demographics
NPI:1801873583
Name:RACKLEY, DONNA BUTLER (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BUTLER
Last Name:RACKLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CORPORATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5968
Mailing Address - Country:US
Mailing Address - Phone:252-758-6080
Mailing Address - Fax:252-758-0009
Practice Address - Street 1:1103 CORPORATE DR STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5968
Practice Address - Country:US
Practice Address - Phone:252-758-6080
Practice Address - Fax:252-758-0009
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800367A00000X
NC50160321363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife