Doctor Name: | ASHLEY D GRAY |
NPI Number: | 1154629178 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R876926 |
Business Practice Address: | 83a Old Mill Creek Rd Enterprise, MS - 393309649 |
Business Phone Number: | 6017041020 |
Business Fax Number: | 6017041021 |
Mailing Address: | 83a Old Mill Creek Rd, ENTERPRISE |
State: | MS |
Postal Code: | 393309649 |
Phone Number: | 6017041020 |
Fax Number: | 6017041021 |
NPI Enumeration Date: | 03/01/2011 |
NPI Last Update Date: | 05/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R876926 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |