Healthcare Provider Details

I. General information

NPI: 1992472567
Provider Name (Legal Business Name): LEXIE GRAY NTP, CPT, CPPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 S CARR CT
LITTLETON CO
80123-1101
US

IV. Provider business mailing address

4328 S CARR CT
LITTLETON CO
80123-1101
US

V. Phone/Fax

Practice location:
  • Phone: 561-314-5334
  • Fax:
Mailing address:
  • Phone: 561-314-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: