Ilya Melina Ray, F.N.P.
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Trevor, WI
NPI 1447639737 · NPPES record last updated Nov 30, 2020
Key facts
- NPI
- 1447639737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 6368 (WI)
- Practice address
- 12530 249TH Cir
Trevor, WI 53179-9135 - Phone
- (262) 298-5251
- NPI assigned
- May 20, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150902001801 | WI | Practitioner - Nurse Practitioner | 2365758539 | Reassigns benefits to 2 organizations |
| I20230425001826 | IL | Practitioner - Nurse Practitioner | 2365758539 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6368 | WI | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vibrant Integrative Psychiatry PLLC | Current |
Accepting new patients | |
| Racine County Finance Department | Current |
Accepting new patients | |
| Vibrant Integrative Psychiatry PLLC | Current |
Accepting new patients | |
| Mathew McCarthy, MD, SC | Past |
Accepting new patients |
Locations
1761 N Dilleys Rd
Ste 211
Gurnee, IL 60031
Phone (224) 285-6006
6530 Sheridan Rd
Ste 3
Kenosha, WI 53143
Phone (224) 285-6006
1717 Taylor Ave
Racine, WI 53403
Phone (262) 638-6635
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 6368 | WI | Yes |
| Family Nurse Practitioner | 363LF0000X | 6368-33 | WI |
Addresses
Primary practice location
12530 249TH Cir
Trevor, WI 53179-9135
Mailing address
12530 249TH Cir
Trevor, WI 53179-9135
Phone (262) 298-5251
Other names
- Mrs. Ilya Melina Collinsworth
Other providers in Trevor, WI
- Pamela Metgzer
- Rae Anne Niles
- Emily Irene Panyk
- Rosemary B Pearson
- Nicole Pignotti
- Kerrie Shurtleff
- Cheyanne Spencer
- Nick Sustache
- Trevor-Wilmot Consolidated Grade School District
- Village of Salem Lakes Kenosha County
All providers in Trevor, WI · Psychiatric/Mental Health Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.