Healthcare Provider Details

I. General information

NPI: 1871906933
Provider Name (Legal Business Name): KAYLEE BRAY AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

1539 ORCHARD GROVE AVE
LAKEWOOD OH
44107-3727
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-4545
  • Fax:
Mailing address:
  • Phone: 713-818-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number137404
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP-15796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: