Provider Demographics
NPI:1700251428
Name:RAY-LEVERETT, DAPHNE MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:MICHELLE
Last Name:RAY-LEVERETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:MICHELLE
Other - Last Name:RAY-LEVERETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:105 HIGHGROVE PLACE
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:678-699-9496
Mailing Address - Fax:
Practice Address - Street 1:105 HIGHGROVE PL
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5979
Practice Address - Country:US
Practice Address - Phone:678-699-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA167925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily