1770699324 NPI number — MS. JANA KATHLEEN RAY BS,MPH,MPAS,DMSCPA-C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770699324 NPI number — MS. JANA KATHLEEN RAY BS,MPH,MPAS,DMSCPA-C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RAY

Provider First Name:

JANA

Provider Middle Name:

KATHLEEN

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

BS,MPH,MPAS,DMSCPA-C

Provider Gender Code:

F

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:

1770699324

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/05/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1334 TAMPA ROAD PMB213

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PALM HARBOR

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

34683

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

850-322-6945

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

CAMP AS SALIYAH

Provider Second Line Business Practice Location Address:

INTERNATIONAL SOS

Provider Business Practice Location Address City Name:

APO

Provider Business Practice Location Address State Name:

AE

Provider Business Practice Location Address Postal Code:

00000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

850-322-6945

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/23/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363AM0700X , with the licence number: PA9102896 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363AM0700X , with the licence number: PA56715 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363A00000X , with the licence number: 006718 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 085.002169 . This is a "DEPT OF FINANCIAL AND PROFESSIONAL REGULATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 385.005610 . This is a "ILLINOIS CONTROLLED SUBSTANCE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 002087 . This is a "IOWA DEPT OF PUBLIC HEALTH MEDICAL LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 292421800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 9874 . This is a "MINNESOTA BOARD OF MEDICAL PRACTICE PHYSICIAN ASST LICENSURE (EXP 06-30-2005)" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 00005751 . This is a "FLORIDA PRESCRIBING QUALIFICATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: AMD-919 . This is a "DEPT OF COMMERCE AND CONSUMER AFFAIRS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: UNKNOWN . This is a "MAGELLAN OF IOWA - BROADLAWNS MEDICAL CENTER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 023740-01 . This is a "DIVISION OF PROFESSIONAL LICENSING SERVICES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: PA56715 . This is a "DEPT OF CONSUMER AFFAIRS - PHY ASST LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1060096 . This is a "NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1721-023 . This is a "WISCONSIN DEPT OF REGULATION AND LICENSING" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
• Identifier: 6718 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: U8969Z . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 5101395 . This is a "IOWA CONTROLLED SUBSTANCE ACT LICENSE (EXPIRED)" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 9102896 . This is a "FLORIDA DEPT OF HEALTH PHYSICIAN ASST LICENSURE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".