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NPI Code Detail

MEDICARE: KENDRIA GRAYS

MEDICARE: KENDRIA GRAYS
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
1164W00000XLicensed Practical Nurse2-074766AL

Other Identifiers

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

General Provider Information

NPI Number : 1790627602
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRIA GRAYS
Provider Business Mailing Address
First Line : 1131 EAGLETREE LN SW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35801-6491
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4040 MEMORIAL PKWY SW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35802-4364
Country : US
Telephone Number : 256-533-1970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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Directions to “ KENDRIA GRAYS ” Practice Location

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