Provider Demographics
NPI:1306185905
Name:RAY, DON A (CRNA)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:A
Last Name:RAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1553
Mailing Address - Country:US
Mailing Address - Phone:270-274-0480
Mailing Address - Fax:270-274-0482
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2750
Practice Address - Country:US
Practice Address - Phone:800-737-7011
Practice Address - Fax:812-547-0174
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007891367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007891OtherAPRN LICENSE
KY1082340OtherRN LICENSE