Provider Demographics
NPI:1659991354
Name:RAY, KALIE (RM, CPM)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:RM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-1888
Mailing Address - Country:US
Mailing Address - Phone:970-903-2111
Mailing Address - Fax:970-507-6003
Practice Address - Street 1:279 DEER TRL
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9637
Practice Address - Country:US
Practice Address - Phone:970-903-2111
Practice Address - Fax:970-507-6003
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR.000194176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife