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General NPI Number Information
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NPI Number | 1558059451
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Entity Type | Individual
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Provider Name | AMANDA NICOLE RAY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 08/17/2024
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Provider Practice Location Address
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Address Line | 7255 N CEDAR AVE STE 101
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City | FRESNO
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State | CA
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Zip | 93720-3831
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Country | US
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Telephone | 559-478-4757
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Fax |
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Provider Business Mailing Address
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Address Line | 1761 N ORANGEWOOD AVE
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City | CLOVIS
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State | CA
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Zip | 93619-3744
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Country | US
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Telephone | 559-392-2636
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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 | 95025916
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 728360
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License Number State | CA
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