Provider Demographics
NPI:1942852728
Name:RAY, KATELYN MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:MARZOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5600
Mailing Address - Fax:540-564-5601
Practice Address - Street 1:1931 MEDICAL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3437
Practice Address - Country:US
Practice Address - Phone:540-564-5600
Practice Address - Fax:540-564-5601
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177813363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942852728Medicaid