Provider Demographics
NPI:1831948041
Name:BRAY, ANDREW THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:BRAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:638 E COLLEGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2363
Mailing Address - Country:US
Mailing Address - Phone:606-318-3500
Mailing Address - Fax:606-318-3503
Practice Address - Street 1:638 E COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2363
Practice Address - Country:US
Practice Address - Phone:606-318-3500
Practice Address - Fax:606-318-3503
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA3510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101029280Medicaid