1669889457 NPI number — HANNAH GRAY FNP

Table of content: HANNAH GRAY FNP (NPI 1669889457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669889457 NPI number — HANNAH GRAY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
HANNAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669889457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 DAVIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-5708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-693-0118
Provider Business Mailing Address Fax Number:
601-553-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 BIRCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE KALB
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39328-8017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-743-2643
Provider Business Practice Location Address Fax Number:
601-553-8175
Provider Enumeration Date:
07/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R882611 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03486259 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com