Individual
DR. NICKLYA M. HARRIS-RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1401 FLORIDA ST, MANDEVILLE, LA 70448-5433
(786) 395-1573
Mailing address
45 HARDY COURT CTR, STE 136, GULFPORT, MS 39507-2501
(786) 395-1573
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DPM200002
LA
213E00000X
Podiatrist
E4806
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1582671
—
LA
01
—
P00440632
MEDICARE RAILROAD
LA
Enumeration date
05/19/2006
Last updated
02/27/2025
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