Provider Demographics
NPI:1336471515
Name:BRAY, CARLA H (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:H
Last Name:BRAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 ALCORN DR
Mailing Address - Street 2:STE 2C
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9073
Mailing Address - Country:US
Mailing Address - Phone:662-286-0088
Mailing Address - Fax:662-286-0067
Practice Address - Street 1:121 PRATT DR
Practice Address - Street 2:SUITE 1 A
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6026
Practice Address - Country:US
Practice Address - Phone:662-286-0088
Practice Address - Fax:662-286-0067
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05539595Medicaid
MS30250I3583OtherMEDICARE
MSP00846492OtherRAILROAD MEDICARE
MS302I507733OtherMEDICARE