=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104734615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY ANN PRAY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2026
-----------------------------------------------------
Last Update Date | 08/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 W 9TH ST
-----------------------------------------------------
City | HOISINGTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67544-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-653-2114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 W COMMERCIAL ST
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67554-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-202-3244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------