1962607291 NPI number — MRS. TRENDA DAYLE RAY APN

Table of content: MRS. TRENDA DAYLE RAY APN (NPI 1962607291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962607291 NPI number — MRS. TRENDA DAYLE RAY APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
TRENDA
Provider Middle Name:
DAYLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1962607291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 EPERNAY CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-868-4706
Provider Business Mailing Address Fax Number:
501-364-5869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MARSHALL ST
Provider Second Line Business Practice Location Address:
SLOT 667
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72202-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-364-4506
Provider Business Practice Location Address Fax Number:
501-364-6710
Provider Enumeration Date:
06/18/2007

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: 363LP0200X , with the licence number:  A01477 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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