Provider Demographics
NPI:1588918452
Name:RAINES, KENDRA LATRICE (APRN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LATRICE
Last Name:RAINES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W MOORES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2755
Mailing Address - Country:US
Mailing Address - Phone:706-975-6990
Mailing Address - Fax:
Practice Address - Street 1:208 W MOORES CROSSING RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-2755
Practice Address - Country:US
Practice Address - Phone:706-975-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA216468363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health