Provider Demographics
NPI:1861512998
Name:RAY, KATHY RUTH (CNM, CAC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:RUTH
Last Name:RAY
Suffix:
Gender:F
Credentials:CNM, CAC
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1413 RED ROCK DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5647
Mailing Address - Country:US
Mailing Address - Phone:505-409-7200
Mailing Address - Fax:
Practice Address - Street 1:516 E NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5748
Practice Address - Country:US
Practice Address - Phone:505-726-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622OtherCERTIFIED NURSE MIDWIFE
TNRN0000103139OtherRN LICENSURE