Individual provider Active NPI

Shelley S Wray, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1447649975
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NP-1746A Issued in ID
Practice address
2321 E Gala St Ste 3
Meridian, ID 83642-7692
Phone
(208) 888-5848
Fax
(208) 888-0884
NPI assigned
Jan 21, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP-1476A ID
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP-1746A ID Primary

Addresses

Primary practice location

2321 E Gala St Ste 3
Meridian, ID 83642-7692

Mailing address

2321 E Gala St Ste 3
Meridian, ID 83642-7692
Phone (208) 888-5848

Other identifiers 1

IdentifierTypeStateIssuer
1447649975MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20150505000995 ID Practitioner - Nurse Practitioner 4183943657 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Midvalley Healthcare PLLCGroup PAC ID 0749327880, 17 clinicians

Practice addresses (Care Compare)

2321 E Gala St
Suite 3
Meridian, ID 83642-7692
Phone (208) 888-5848

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-1476AIDMDPsychiatric/Mental Health Nurse Practitioner
NP-1746AIDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midvalley Healthcare PLLC CurrentSince Sep 22, 2022 Accepting new patients

Locations

303 N Allumbaugh St
Ste 335
Boise, ID 83704
Phone (208) 888-5848

2321 E Gala St
Ste 3
Meridian, ID 83642
Phone (208) 288-2280

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": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1447649975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 E GALA ST STE 3",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427692",
            "telephone_number": "208-888-5848",
            "fax_number": "208-888-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 E GALA ST STE 3",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427692",
            "telephone_number": "208-888-5848",
            "fax_number": "208-888-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAY",
        "first_name": "SHELLEY",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-21",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "NP-1476A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "NP-1746A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447649975",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.