Healthcare Provider Details

I. General information

NPI: 1558059451
Provider Name (Legal Business Name): AMANDA NICOLE RAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NICOLE HUNTER NP

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7255 N CEDAR AVE STE 101
FRESNO CA
93720-3831
US

IV. Provider business mailing address

1761 N ORANGEWOOD AVE
CLOVIS CA
93619-3744
US

V. Phone/Fax

Practice location:
  • Phone: 559-478-4757
  • Fax:
Mailing address:
  • Phone: 559-392-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025916
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number728360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: