Healthcare Provider Details

I. General information

NPI: 1114697778
Provider Name (Legal Business Name): ERIKA ELIZABETH RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2429
US

IV. Provider business mailing address

1601 YALE AVE
METAIRIE LA
70003-3611
US

V. Phone/Fax

Practice location:
  • Phone: 504-289-8555
  • Fax:
Mailing address:
  • Phone: 504-289-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number234082
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116282
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: