Provider Demographics
NPI:1477648517
Name:RAY, KATHRYN ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2334
Mailing Address - Country:US
Mailing Address - Phone:580-256-2188
Mailing Address - Fax:580-256-2281
Practice Address - Street 1:916 19TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2334
Practice Address - Country:US
Practice Address - Phone:580-256-2188
Practice Address - Fax:580-256-2281
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126380AMedicaid
OKG87545Medicare UPIN
OK100126380AMedicaid