Provider Demographics
NPI:1598831422
Name:RAY, KRISTINA E (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:E
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:NICOLE
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6353 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-4453
Mailing Address - Country:US
Mailing Address - Phone:251-410-7425
Mailing Address - Fax:
Practice Address - Street 1:6353 2ND ST
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:AL
Practice Address - Zip Code:36587-4453
Practice Address - Country:US
Practice Address - Phone:251-865-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27374207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL157003Medicaid
AL511-42443OtherBLUE CROSS BLUE SHIELD
AL102I112779Medicare PIN