Provider Demographics
NPI:1114942216
Name:KRAY, STEPHANIE JO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JO
Last Name:KRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:JOE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49725 COUNTY 83
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-5280
Mailing Address - Country:US
Mailing Address - Phone:218-894-1515
Mailing Address - Fax:218-894-8767
Practice Address - Street 1:49725 COUNTY 83
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-5280
Practice Address - Country:US
Practice Address - Phone:218-894-1515
Practice Address - Fax:218-894-8767
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN18F30KROtherBCBS OF MINNESOTA
992491OtherAMERICA'S PPO
HP29219OtherHEALTH PARTNERS
NA9231017076OtherPREFERRED ONE
MN151305C736OtherUCARE MINNESOTA
MN506380900Medicaid
MNA019OtherTRICARE
0105822OtherMEDICA
HP29219OtherHEALTH PARTNERS
0105822OtherMEDICA
MN151305C736OtherUCARE MINNESOTA