Provider Demographics
NPI:1235679085
Name:RAY, TERESA (AGACNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 CARROLLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3034
Mailing Address - Country:US
Mailing Address - Phone:276-601-6197
Mailing Address - Fax:276-601-6156
Practice Address - Street 1:5261 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3034
Practice Address - Country:US
Practice Address - Phone:276-601-6197
Practice Address - Fax:276-601-6156
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174194363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology