MEDICARE: KENDRA GRAY PHD PLC

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	103TC0700X	Clinical Psychologist	1752	KY

General Provider Information

NPI Number	:	1730554767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDRA GRAY PHD PLC

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

Provider Business Practice Location Address
First Line	:	109 N MAIN ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-3101
Country	:	US
Telephone Number	:	812-491-1307
Fax Number	:	270-495-4284

Authorized Official
Title or Position	:	MEMBER
Name	:	KENDRA M GRAY
Credential	:	PHD
Telephone Number	:	270-984-8140

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	11/09/2020

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