Provider Demographics
NPI:1336678127
Name:RAY, CONSTANCE NICHOLS (RN/CPNP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:NICHOLS
Last Name:RAY
Suffix:
Gender:F
Credentials:RN/CPNP
Other - Prefix:MISS
Other - First Name:CONSTANCE
Other - Middle Name:MARIE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:
Practice Address - Street 1:4001 WEST 15TH STREET, SUITE 375
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5862
Practice Address - Country:US
Practice Address - Phone:972-612-5346
Practice Address - Fax:972-599-1331
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237290163W00000X
TXAP108817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse