Individual provider Active NPI

Corinne Janel Wray, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Great Bend, KS
National Provider Identifier
1770115115
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
53-80317-121 Issued in KS
Practice address
5815 Broadway Ave
Great Bend, KS 67530-3123
Phone
(620) 792-2544
NPI assigned
Feb 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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 53-80317-121 KS Primary

Addresses

Primary practice location

5815 Broadway Ave
Great Bend, KS 67530-3123

Mailing address

5815 Broadway Ave
Great Bend, KS 67530-3197
Phone (620) 792-2544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20240911001147 KS Practitioner - Nurse Practitioner 0547700023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Center for Counseling and ConsultationGroup PAC ID 2961458518, 14 clinicians

Practice addresses (Care Compare)

5815 Broadway Ave
Great Bend, KS 67530-3123
Phone (620) 792-2544

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53-80317-121KSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Counseling and Consultation CurrentSince Jul 22, 2024 Accepting new patients
Pawnee Mental Health Service, Inc. Past Accepting new patients

Locations

5815 Broadway Ave
Great Bend, KS 67530
Phone (620) 792-2544

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1770115115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5815 BROADWAY AVE",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303197",
            "telephone_number": "620-792-2544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5815 BROADWAY AVE",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303123",
            "telephone_number": "620-792-2544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAY",
        "first_name": "CORINNE",
        "middle_name": "JANEL",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-04",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KS",
            "license": "53-80317-121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Bend, KS

Sources for this page

Verify at the official NPI Registry.