Provider Demographics
NPI:1528241999
Name:O'CONNOR-WRAY, KATHY MICHELLE (DNP, APN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MICHELLE
Last Name:O'CONNOR-WRAY
Suffix:
Gender:F
Credentials:DNP, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:107 PEPPER TREE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8865
Mailing Address - Country:US
Mailing Address - Phone:731-225-3639
Mailing Address - Fax:731-265-6198
Practice Address - Street 1:8 STONEBRIDGE BLVD STE M
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2178
Practice Address - Country:US
Practice Address - Phone:731-265-6197
Practice Address - Fax:731-265-6198
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529265Medicaid