Basic Information
| Provider Information | |||||||||
| NPI: | 1023052206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAINEY | ||||||||
| FirstName: | LETITIA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24730 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372024730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862300 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 CHARLOTTE AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152221900 | ||||||||
| FaxNumber: | 6152221917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 12/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 4141489 | 01 | TN | BLUE CROSS | OTHER | 3660848 | 05 | TN | MEDICAID |