MEDICARE: JESSICA GRAY CERTIFIED

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	374J00000X	Doula		KS

General Provider Information

NPI Number	:	1750248084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GRAY CERTIFIED

Provider Business Mailing Address
First Line	:	1133 N OLD MANOR RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-2721
Country	:	US
Telephone Number	:	786-760-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N OLD MANOR RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-2721
Country	:	US
Telephone Number	:	786-760-2047
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ JESSICA GRAY CERTIFIED” Practice Location

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