Healthcare Provider Details

I. General information

NPI: 1124346994
Provider Name (Legal Business Name): MANDELYNN GRACE ANN PRAY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDELYNN GRACE ANN MORGAN

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E 19TH ST SUITE 209
THE DALLES OR
97058-3388
US

IV. Provider business mailing address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-5657
  • Fax: 541-298-5199
Mailing address:
  • Phone: 541-296-5452
  • Fax: 541-296-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201050099NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAWARDED JUNE 2010
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: