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General NPI Number Information
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NPI Number | 1104590751
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Entity Type | Individual
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Provider Name | JESSICA LYNN BRAY ANP-C
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 2490 S WOODWORTH LOOP STE 200
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City | PALMER
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State | AK
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Zip | 99645-7410
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Country | US
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Telephone | 907-861-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 3133 E WHISPERING WOODS DR
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City | WASILLA
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State | AK
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Zip | 99654-7467
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Country | US
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Telephone | 406-781-3603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 182046
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License Number State | AK
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