Provider Demographics
NPI:1003801986
Name:RAY, AMY HAYDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:HAYDEN
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2200 E. PARRISH AVE
Mailing Address - Street 2:BLDG B, STE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3232
Mailing Address - Fax:270-852-1600
Practice Address - Street 1:2200 E. PARRISH AVE
Practice Address - Street 2:BLDG B, STE 101
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3232
Practice Address - Fax:270-852-1600
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000345566OtherID BLUE CROSS INSURANCE
000000345566OtherBLUE CROSS
KY64082597Medicaid
KY50006859OtherPASSPORT NON-PARTICIPATE
I05306Medicare UPIN
0650808Medicare PIN