Provider Demographics
NPI:1164557351
Name:BRAY, CONNIE F (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:F
Last Name:BRAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576
Mailing Address - Country:US
Mailing Address - Phone:870-895-2541
Mailing Address - Fax:870-895-2957
Practice Address - Street 1:507 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576
Practice Address - Country:US
Practice Address - Phone:870-895-2541
Practice Address - Fax:870-895-2957
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCRNA369367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59781Medicare PIN