Provider Demographics
NPI:1386900298
Name:RAY, PAMELA
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3238
Mailing Address - Country:US
Mailing Address - Phone:405-793-4214
Mailing Address - Fax:
Practice Address - Street 1:2948 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3238
Practice Address - Country:US
Practice Address - Phone:405-793-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program