Provider Demographics
NPI:1689268815
Name:MCCRAY, DEBRA B
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:B
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 RASBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2538
Mailing Address - Country:US
Mailing Address - Phone:318-218-4968
Mailing Address - Fax:
Practice Address - Street 1:940 ANDREW AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-2311
Practice Address - Country:US
Practice Address - Phone:318-673-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant