MEDICARE: MS. KATHRYN LYNN CRAY C.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	11808-NP	OH
2	363LF0000X	Family Nurse Practitioner	COA.11808-NP	OH

General Provider Information

NPI Number	:	1629387592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN LYNN CRAY C.N.P.

Provider Business Mailing Address
First Line	:	100 MADISON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 W CENTRAL AVE STE 100
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3817
Country	:	US
Telephone Number	:	419-537-5111
Fax Number	:	419-537-5131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	10/21/2024

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