Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 38474 | KY |
NPI | 1003801986 |
---|---|
Provider Name | Dr. Amy Hayden Ray |
First Address | Owensboro, KY 42303-1449 |
Second Address | Owensboro, KY 42303-1449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000345566 | BLUE CROSS (01) | |
000000345566 | ID BLUE CROSS INSURANCE (01) | KY |
50006859 | PASSPORT NON-PARTICIPATE (01) | KY |
64082597 | (05) | KY |
I05306 | (02) |