Provider Demographics
NPI:1508065962
Name:BRAY, ELIZABETH ANNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BRAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:WIKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2915 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9360
Mailing Address - Country:US
Mailing Address - Phone:903-784-4044
Mailing Address - Fax:903-784-4201
Practice Address - Street 1:2915 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9360
Practice Address - Country:US
Practice Address - Phone:903-784-4044
Practice Address - Fax:903-784-4201
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily