Provider Demographics
NPI:1487770186
Name:WRAY, KHAMKET (ARNP-C)
Entity type:Individual
Prefix:
First Name:KHAMKET
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 THORNHILL CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5527
Mailing Address - Country:US
Mailing Address - Phone:561-504-1350
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD STE 306
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7202
Practice Address - Country:US
Practice Address - Phone:561-368-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9221294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9221294OtherARNP LICENSE
FLQ41535Medicare UPIN