Provider Demographics
NPI:1437517281
Name:BRAY, SUNNY (NP-C)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 ROGERS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3121
Mailing Address - Country:US
Mailing Address - Phone:479-384-5380
Mailing Address - Fax:479-384-5382
Practice Address - Street 1:4620 ROGERS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3121
Practice Address - Country:US
Practice Address - Phone:479-384-5380
Practice Address - Fax:479-384-5382
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR212334758Medicaid