Provider Demographics
NPI:1760777874
Name:RAY, CAROLINE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RAY
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 1:111 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-2634
Mailing Address - Country:US
Mailing Address - Phone:870-598-1122
Mailing Address - Fax:870-598-1123
Practice Address - Street 1:111 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2634
Practice Address - Country:US
Practice Address - Phone:870-598-1122
Practice Address - Fax:870-598-1123
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator