Provider Demographics
NPI:1699755108
Name:MCCRAY, KATIE ANN (RPA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:KUROSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-0398
Mailing Address - Country:US
Mailing Address - Phone:409-267-3143
Mailing Address - Fax:409-267-4443
Practice Address - Street 1:2660 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7606
Practice Address - Country:US
Practice Address - Phone:713-343-2679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010681363AM0700X
TXPA06286363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0991Medicare ID - Type Unspecified
TX8L19196Medicare PIN