Provider Demographics
NPI:1801107834
Name:RAY, MEGHANN REYNOLDS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGHANN
Middle Name:REYNOLDS
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8014
Mailing Address - Country:US
Mailing Address - Phone:812-473-2060
Mailing Address - Fax:
Practice Address - Street 1:1401 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8014
Practice Address - Country:US
Practice Address - Phone:812-473-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA3173363A00000X
NC001003167363A00000X
MSPA00135363A00000X
IN10002829A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1341PAMedicaid
NC1683JOtherBCBSNC
NCP01223903OtherMEDICARE-RAILROAD
KY7100886350Medicaid
9657842OtherAENTA
IN300072217Medicaid
SC834026OtherWELLCARE OF SC
NC8102481Medicaid