Provider Demographics
NPI:1841249257
Name:RAY, AMY LYNN (MSN, MPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:RAY
Suffix:
Gender:F
Credentials:MSN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5056
Mailing Address - Country:US
Mailing Address - Phone:918-710-4200
Mailing Address - Fax:918-403-6331
Practice Address - Street 1:7501 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-710-4200
Practice Address - Fax:918-403-6331
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK105626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512955Medicaid
OK200463330AMedicaid
TN1512955Medicaid