Provider Demographics
NPI:1649927120
Name:RAY, MEGAN ELISE (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:RAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5940 FOREST PARK RD APT 3107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6464
Mailing Address - Country:US
Mailing Address - Phone:817-371-2262
Mailing Address - Fax:
Practice Address - Street 1:8220 WALNUT HILL LN STE 206
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4406
Practice Address - Country:US
Practice Address - Phone:214-739-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA15416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant