Provider Demographics
NPI:1720573959
Name:RAY, ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:15190 COMMUNITY RD STE 140
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3484
Practice Address - Country:US
Practice Address - Phone:228-539-0489
Practice Address - Fax:228-539-0492
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2021-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS902629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04437305Medicaid