Provider Demographics
NPI:1881835163
Name:FRAY, PATRICIA KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY
Last Name:FRAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-453-1039
Mailing Address - Fax:425-453-8955
Practice Address - Street 1:1200 112TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3732
Practice Address - Country:US
Practice Address - Phone:425-453-1039
Practice Address - Fax:425-453-8955
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60071357364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1881835163Medicaid
WA1881835163Medicaid