Provider Demographics
NPI:1043838089
Name:RAY, MIRANDA LYNN
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LYNN
Last Name:RAY
Suffix:
Gender:F
Credentials:
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 234
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:75976-9010
Mailing Address - Country:US
Mailing Address - Phone:936-240-5245
Mailing Address - Fax:
Practice Address - Street 1:7842 COUNTY ROAD 2707
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:TX
Practice Address - Zip Code:75925-6032
Practice Address - Country:US
Practice Address - Phone:936-240-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant