Provider Demographics
NPI:1366978033
Name:CLIETT, RAINA (NP)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:CLIETT
Suffix:
Gender:F
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:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2029
Mailing Address - Country:US
Mailing Address - Phone:912-871-5000
Mailing Address - Fax:912-681-1444
Practice Address - Street 1:106 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2459
Practice Address - Country:US
Practice Address - Phone:912-871-5000
Practice Address - Fax:912-681-1444
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231621363LF0000X
GA231621363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily