MEDICARE: GRAYSON STOCKWELL 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	1106879	TX

General Provider Information

NPI Number	:	1861369068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAYSON STOCKWELL FNP-C

Provider Business Mailing Address
First Line	:	469 COUNTY ROAD 2098
Second Line	:
City	:	LIBERTY
State	:	TX
Zip	:	77575-6583
Country	:	US
Telephone Number	:	832-785-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S PRAIRIE ST
Second Line	:
City	:	DAYTON
State	:	TX
Zip	:	77535-2819
Country	:	US
Telephone Number	:	936-340-5517
Fax Number	:

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

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	12/08/2025

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Directions to “ GRAYSON STOCKWELL FNP-C” Practice Location

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