Provider Demographics
NPI:1952885709
Name:BRAY, NIKIA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:NIKIA
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5525
Mailing Address - Country:US
Mailing Address - Phone:860-972-2334
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 601
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5525
Practice Address - Country:US
Practice Address - Phone:860-972-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284920363LF0000X
CT009297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110147488AMedicaid
MAS400793915OtherMEDICARE