Individual provider Active NPI

Lara Danielle Ray, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Cedar Bluff, VA
National Provider Identifier
1114710316
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0024193565 Issued in VA
Practice address
1113 Cedar Valley Dr
Cedar Bluff, VA 24609-9190
Phone
(276) 963-0111
NPI assigned
May 28, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0024193565 VA Primary

Addresses

Primary practice location

1113 Cedar Valley Dr
Cedar Bluff, VA 24609-9190

Mailing address

1113 Cedar Valley Dr
Cedar Bluff, VA 24609-9190
Phone (276) 963-0111

Other practice location 1

112 E Main St
Abingdon, VA 24210-2808
Phone (276) 963-0111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250903000016 VA Practitioner - Nurse Practitioner 1153822887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healing Waters Counseling CenterGroup PAC ID 9931362399, 16 clinicians

Practice addresses (Care Compare)

1113 Cedar Valley Dr
Cedar Bluff, VA 24609-9190
Phone (276) 963-0111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0024193565VAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Waters Counseling Center Psychiatric/Mental Health CurrentSince Jun 24, 2025 Accepting new patients

Locations

185 Redwood Ave
Ste 102B
Pennington Gap, VA 24277
Phone (276) 963-0111

169 Suffolk Ave
Ste 1
Richlands, VA 24641
Phone (276) 821-2260

106 Spring Ave NE
Wise, VA 24293
Phone (276) 533-3193

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1114710316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 CEDAR VALLEY DR",
            "city": "CEDAR BLUFF",
            "state": "VA",
            "postal_code": "246099190",
            "telephone_number": "276-963-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 CEDAR VALLEY DR",
            "city": "CEDAR BLUFF",
            "state": "VA",
            "postal_code": "246099190",
            "telephone_number": "276-963-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 E Main St",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242102808",
            "country_code": "US",
            "telephone_number": "276-963-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAY",
        "first_name": "LARA",
        "middle_name": "DANIELLE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024193565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Bluff, VA

Sources for this page

Verify at the official NPI Registry.