Provider Demographics
NPI:1326513920
Name:RAY, JACQUELYN BRUNER (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:BRUNER
Last Name:RAY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:365 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-8916
Mailing Address - Country:US
Mailing Address - Phone:832-687-2518
Mailing Address - Fax:
Practice Address - Street 1:4711 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2622
Practice Address - Country:US
Practice Address - Phone:601-485-7777
Practice Address - Fax:601-485-7766
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902970363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health