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General NPI Number Information
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NPI Number | 1932880333
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Entity Type | Individual
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Provider Name | ELLEN RAY
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 4525 MID RIVERS MALL DR STE 10
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City | COTTLEVILLE
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State | MO
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Zip | 63376-2820
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Country | US
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Telephone | 636-229-3350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6442
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Country | US
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Telephone | 636-229-3350
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Fax | 636-229-3355
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2023033858
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 2005005840
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License Number State | MO
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