Provider Demographics
NPI:1841877024
Name:FENLEY, RAY (NP)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:FENLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 AMBER WHEAT CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-7113
Mailing Address - Country:US
Mailing Address - Phone:817-897-6363
Mailing Address - Fax:
Practice Address - Street 1:104 WHISPERING PINES AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4911
Practice Address - Country:US
Practice Address - Phone:281-819-1438
Practice Address - Fax:877-255-0161
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034285363LP0808X
TX863633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse