Basic Information
| Provider Information | |||||||||
| NPI: | 1487683454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYES-PRINCE | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAYES | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | JANE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 108 GROVE ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8339632102 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2208 W ROOSEVELT BLVD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281102762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042899869 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 33653 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | KY33653 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2084A0401X | 2009-01802 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2081P2900X | 33653 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000357941 | 01 | KY | BLUE CROSS | OTHER | 64336530 | 05 | KY | MEDICAID | BR4946262 | 01 | KY | DEA | OTHER |