Provider Demographics
NPI:1790118453
Name:RAY, AMANDA LAUREN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LAUREN
Last Name:RAY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:RAY
Other - Last Name:BOUTERIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 DRURY LANE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:100 DRURY LANE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-269-4949
Practice Address - Fax:337-269-4950
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200634363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical