Provider Demographics
NPI:1669782603
Name:RAY, NICOLE B (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:B
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2579 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-9181
Mailing Address - Country:US
Mailing Address - Phone:828-692-4289
Mailing Address - Fax:
Practice Address - Street 1:2579 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792
Practice Address - Country:US
Practice Address - Phone:828-692-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant