Provider Demographics
NPI:1043697477
Name:RAINES, SELENA G (DO)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:G
Last Name:RAINES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1795 ALYSHEBA WAY STE 2101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2286
Mailing Address - Country:US
Mailing Address - Phone:859-287-2827
Mailing Address - Fax:859-203-8684
Practice Address - Street 1:1795 ALYSHEBA WAY STE 2101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2286
Practice Address - Country:US
Practice Address - Phone:859-287-2827
Practice Address - Fax:859-203-8684
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY04162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100497270Medicaid