Provider Demographics
NPI:1932911120
Name:RAY, TAWNYA LEE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:LEE
Last Name:RAY
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3974
Mailing Address - Country:US
Mailing Address - Phone:435-339-4747
Mailing Address - Fax:
Practice Address - Street 1:494 S MAIN ST STE 230
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2241
Practice Address - Country:US
Practice Address - Phone:801-673-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT335646-3102261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty