Individual
MARY JO RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
400 N 17TH ST, KEOKUK, IA 52632-3452
(319) 524-5734
(319) 524-5758
Mailing address
400 N 17TH ST, KEOKUK, IA 52632-3452
(319) 524-5734
(319) 524-5758
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
041-138505
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
C076938
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33627
BLUE CROSS BLUE SHIELD
—
01
—
421527584
TRI-CARE GROUP NUMBER
—
05
—
421527584003
—
IL
01
—
42152758405
JOHN DEERE
—
05
—
429203201
—
MO
05
—
O278374
—
IA
Enumeration date
05/27/2005
Last updated
09/20/2013
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