Provider Demographics
NPI:1225025901
Name:RAY, KRISTA MARLENE (APN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARLENE
Last Name:RAY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MARLENE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:KIDNEY CENTER BOX 328
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6263
Practice Address - Fax:720-777-7199
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001956363L00000X
COAPN.0992107363LF0000X
COAPN.0992107-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily