Provider Demographics
NPI:1306455860
Name:RAY, WENDY MICHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELLE
Last Name:RAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 REBECCA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-3959
Mailing Address - Country:US
Mailing Address - Phone:870-723-3960
Mailing Address - Fax:
Practice Address - Street 1:1012 E CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-3530
Practice Address - Country:US
Practice Address - Phone:870-226-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123955363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health