Healthcare Provider Details

I. General information

NPI: 1003531518
Provider Name (Legal Business Name): MARINA TAYLOR GRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARINA ENGLAND

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 RODGERS DR
SEARCY AR
72143-7433
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-7979
  • Fax: 501-305-3535
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number222081
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: