Provider Demographics
NPI:1164503660
Name:RAY, KRISTEN A (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VAMC WHITE RIVER JCT
Mailing Address - Street 2:215 N. MAIN ST (111E)
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05009-0001
Mailing Address - Country:US
Mailing Address - Phone:802-295-9363
Mailing Address - Fax:802-296-6395
Practice Address - Street 1:VAMC WHITE RIVER JCT
Practice Address - Street 2:215 N. MAIN ST (111E)
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:802-296-6395
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063039-23363LF0000X
VT101.0110430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ863630Medicaid
AZZ81208Medicare PIN
AZ863630Medicaid