Basic Information
| Provider Information | |||||||||
| NPI: | 1639754237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANN-RAY | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CPRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 FOXPORT RD | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376645626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234804090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 917 W WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2021 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
No ID Information.