Provider Demographics
NPI:1528163599
Name:RAY, CHARLENE A (MSN, ANP-C)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 41208
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-1208
Mailing Address - Country:US
Mailing Address - Phone:910-615-6691
Mailing Address - Fax:910-615-5398
Practice Address - Street 1:1638 OWEN DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-6691
Practice Address - Fax:910-615-5398
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-01614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2594249Medicare PIN