Provider Demographics
NPI:1861664559
Name:BRAY, JOANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14121 PARKE LONG CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1647
Mailing Address - Country:US
Mailing Address - Phone:855-247-1940
Mailing Address - Fax:
Practice Address - Street 1:75 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-566-4880
Practice Address - Fax:740-566-4881
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 09933-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA09933-NPOtherLICENSE