Provider Demographics
NPI:1447388608
Name:RAY, TRACY D (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:RAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 OSAGE STREET
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1714
Mailing Address - Country:US
Mailing Address - Phone:308-254-5825
Mailing Address - Fax:308-254-7258
Practice Address - Street 1:645 OSAGE STREET
Practice Address - Street 2:SIDNEY REGIONAL MEDICAL CENTER
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1714
Practice Address - Country:US
Practice Address - Phone:308-254-5825
Practice Address - Fax:308-254-7258
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK733363A00000X
NE1095363A00000X
KS15-01049363A00000X
IA1870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant