MEDICARE: MS. DEANNA S GRAY NP

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	AP125708	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639194012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNA S GRAY NP

Provider Business Mailing Address
First Line	:	5253 PRUE RD, BUILDING 1
Second Line	:	STE 100C
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1161
Country	:	US
Telephone Number	:	210-750-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5253 PRUE RD, BUILDING 1
Second Line	:	STE 100C
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1758
Country	:	US
Telephone Number	:	210-750-8100
Fax Number	:	210-750-8101

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/23/2024

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