Provider Demographics
NPI:1720597305
Name:RAY, MARY (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9547 HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-9415
Mailing Address - Country:US
Mailing Address - Phone:615-300-4168
Mailing Address - Fax:
Practice Address - Street 1:181 MILL ST
Practice Address - Street 2:
Practice Address - City:LYNNVILLE
Practice Address - State:TN
Practice Address - Zip Code:38472-3138
Practice Address - Country:US
Practice Address - Phone:931-908-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000022401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily