Provider Demographics
NPI:1992050959
Name:RAY, CAROL LEE (APRN, ACNS-BC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:RAY
Suffix:
Gender:F
Credentials:APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 JAMES CASEY ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1120
Mailing Address - Country:US
Mailing Address - Phone:512-448-4588
Mailing Address - Fax:512-445-4511
Practice Address - Street 1:4310 JAMES CASEY ST STE 4A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1120
Practice Address - Country:US
Practice Address - Phone:512-448-4588
Practice Address - Fax:512-445-4511
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534331364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health