Provider Demographics
NPI:1255435699
Name:MCCRAY, KERRY M (NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:M
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 VIRGINIA ST UNIT 605
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-4172
Mailing Address - Country:US
Mailing Address - Phone:928-925-1940
Mailing Address - Fax:
Practice Address - Street 1:301 VIRGINIA ST UNIT 605
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-4172
Practice Address - Country:US
Practice Address - Phone:928-925-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01966363LF0000X
NH079676-23363LF0000X
VT101.0134309363LF0000X
WAAP60724954363LF0000X
DCRN1032372363LF0000X
MDAC002147363LF0000X
AZAP7736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010229138Medicaid
VA010229138Medicaid
VAVAA113510Medicare PIN
009394M93Medicare ID - Type Unspecified