Provider Demographics
NPI:1518740927
Name:WRAY, AMANDA KELLEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KELLEY
Last Name:WRAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 VIKING LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3836
Mailing Address - Country:US
Mailing Address - Phone:804-629-5818
Mailing Address - Fax:
Practice Address - Street 1:2207 VIKING LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3836
Practice Address - Country:US
Practice Address - Phone:804-629-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187690363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health