Provider Demographics
NPI:1336705813
Name:RAY, CANDRA NICOLE (MNSC, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CANDRA
Middle Name:NICOLE
Last Name:RAY
Suffix:
Gender:F
Credentials:MNSC, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3902
Mailing Address - Country:US
Mailing Address - Phone:479-595-3974
Mailing Address - Fax:
Practice Address - Street 1:813 FOUNDERS PARK DR E STE 203
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6322
Practice Address - Country:US
Practice Address - Phone:479-463-2440
Practice Address - Fax:479-463-2465
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner