Healthcare Provider Details

I. General information

NPI: 1073214540
Provider Name (Legal Business Name): RICHI MICHELE GRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BRYAN BLVD
CORBIN KY
40701-2775
US

IV. Provider business mailing address

8786 KY 459
BARBOURVILLE KY
40906-7236
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-2005
  • Fax:
Mailing address:
  • Phone: 606-243-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3018730
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: