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General NPI Number Information
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NPI Number | 1366108938
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Entity Type | Organization
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Legal Business Name | RAYJOHN MENTHEALTH PC-NP
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 3715 W BARSTOW AVE APT 215
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City | FRESNO
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State | CA
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Zip | 93711-6667
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Country | US
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Telephone | 559-825-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 BRIGHTON PASS
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City | CONYERS
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State | GA
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Zip | 30094-3357
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOUISE THOMPSON
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Credential | NP
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Telephone | 559-825-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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