Healthcare Provider Details

I. General information

NPI: 1467759936
Provider Name (Legal Business Name): ADRIAN DENISE GRAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 CUMBERLAND FALLS HWY STE D141
CORBIN KY
40701-2796
US

IV. Provider business mailing address

PO BOX 129
WHITLEY CITY KY
42653-0129
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-5527
  • Fax: 606-526-9687
Mailing address:
  • Phone: 606-376-2224
  • Fax: 606-376-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006853
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: