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Individual

MS. KELLY LEE RAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1581 OLD HWY 66, UNIT 1, EDGEWOOD, NM, NM 87015
(505) 286-2396
(505) 286-2398
Mailing address
13017 BLUECORN MAIDEN TRL NE, ALBUQUERQUE, NM 87112-3730
(505) 967-7609
(505) 312-7697

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2010-0035
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
07533322
NM
Enumeration date
08/19/2010
Last updated
08/15/2024
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