Provider Demographics
NPI:1679935357
Name:WRAY, KATHRYN NICOLE (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NICOLE
Last Name:WRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 WALNUT HILL LN STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5637
Mailing Address - Country:US
Mailing Address - Phone:214-369-7661
Mailing Address - Fax:
Practice Address - Street 1:7859 WALNUT HILL LN STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5637
Practice Address - Country:US
Practice Address - Phone:214-369-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679935357Medicaid