Provider Demographics
NPI:1336408681
Name:RAY, STEPHEN CREIGHTON (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CREIGHTON
Last Name:RAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 GLENNA GOODACRE BLVD APT 4326
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2280
Mailing Address - Country:US
Mailing Address - Phone:803-269-6818
Mailing Address - Fax:
Practice Address - Street 1:2400 GLENNA GOODACRE BLVD APT 4326
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2280
Practice Address - Country:US
Practice Address - Phone:803-269-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX821573367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered