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General NPI Number Information
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NPI Number | 1275521809
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Entity Type | Individual
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Provider Name | KIRSTEN NICOLE BRAY M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 1617 W GARRISON BLVD
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City | GASTONIA
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State | NC
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Zip | 28052-3635
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Country | US
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Telephone | 704-867-0219
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Fax | 704-867-0216
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Provider Business Mailing Address
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Address Line | PO BOX 98313
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City | RALEIGH
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State | NC
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Zip | 27624-8313
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Country | US
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Telephone | 919-845-0054
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Fax | 919-845-1947
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 2001-00315
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200100315
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License Number State | NC
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