Provider Demographics
NPI:1407193949
Name:MCCRAY, TOREY NICHELLE
Entity Type:Individual
Prefix:
First Name:TOREY
Middle Name:NICHELLE
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1066
Mailing Address - Country:US
Mailing Address - Phone:513-371-2875
Mailing Address - Fax:
Practice Address - Street 1:308 BOONE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1066
Practice Address - Country:US
Practice Address - Phone:513-371-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147566164W00000X
KY2046951164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH147566OtherLPN