Provider Demographics
NPI:1619268901
Name:WRAY, ANDREA MICHELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:WRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:GILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9800 BROADWAY EXT STE 203
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6304
Mailing Address - Country:US
Mailing Address - Phone:405-424-5415
Mailing Address - Fax:405-424-5416
Practice Address - Street 1:9800 BROADWAY EXT STE 203
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6304
Practice Address - Country:US
Practice Address - Phone:405-424-5415
Practice Address - Fax:405-424-5416
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical