Basic Information
| Provider Information | |||||||||
| NPI: | 1003801986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | HAYDEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAYDEN | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2200 E. PARRISH AVE | ||||||||
| Address2: | BLDG B, STE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E. PARRISH AVE | ||||||||
| Address2: | BLDG B, STE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 38474 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000345566 | 01 | KY | ID BLUE CROSS INSURANCE | OTHER | 000000345566 | 01 | BLUE CROSS | OTHER | 64082597 | 05 | KY | MEDICAID | 50006859 | 01 | KY | PASSPORT NON-PARTICIPATE | OTHER |