MEDICARE: GREGORY LEE GRAY MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	729226	TX

General Provider Information

NPI Number	:	1245588763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LEE GRAY MSN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 755
Second Line	:
City	:	WARREN
State	:	TX
Zip	:	77664-0755
Country	:	US
Telephone Number	:	409-289-7727
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 N WHEELER ST
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-3129
Country	:	US
Telephone Number	:	409-384-4336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	04/09/2021

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