1982958260 NPI number — KILYNDA VERNETTE RAY PH.D.

Table of content: KILYNDA VERNETTE RAY PH.D. (NPI 1982958260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982958260 NPI number — KILYNDA VERNETTE RAY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
KILYNDA
Provider Middle Name:
VERNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982958260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8550 W DESERT INN RD STE 102-343
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-4401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-921-5490
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 RAMSEY STREET, BLDG. 50, RM 206
Provider Second Line Business Practice Location Address:
VETERAN'S HEALTH ADMINISTRATION
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-6170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-768-2593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  019871 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 4589 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 25246 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)