Healthcare Provider Details

I. General information

NPI: 1104734615
Provider Name (Legal Business Name): KIMBERLY ANN PRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 9TH ST
HOISINGTON KS
67544-1706
US

IV. Provider business mailing address

507 W COMMERCIAL ST
LYONS KS
67554-2622
US

V. Phone/Fax

Practice location:
  • Phone: 620-653-2114
  • Fax:
Mailing address:
  • Phone: 660-202-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: