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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X38474KYY Allopathic & Osteopathic PhysiciansPediatrics 

ID Information
IDTypeStateIssuerDescription
6408259705KY MEDICAID
00000034556601KYID BLUE CROSS INSURANCEOTHER
00000034556601 BLUE CROSSOTHER
5000685901KYPASSPORT NON-PARTICIPATEOTHER


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