Provider Demographics
NPI:1992446751
Name:WRAY, KRYSTENE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KRYSTENE
Middle Name:
Last Name:WRAY
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 1:4400 BROADWAY BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3342
Mailing Address - Country:US
Mailing Address - Phone:816-931-9344
Mailing Address - Fax:
Practice Address - Street 1:4400 BROADWAY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-931-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021041119363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health