Provider Demographics
NPI:1629215454
Name:NATAPRAYA, KENT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:
Last Name:NATAPRAYA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17016 DOWNING ST
Mailing Address - Street 2:APT 201
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3614
Mailing Address - Country:US
Mailing Address - Phone:240-423-5149
Mailing Address - Fax:
Practice Address - Street 1:2/22 INFANTRYRGT 2 BN
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:240-423-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant