Healthcare Provider Details

I. General information

NPI: 1679981294
Provider Name (Legal Business Name): HEATHER GRAYSON APRN, PNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CONTEMPO AVE
WEST MONROE LA
71291-5312
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-5437
  • Fax: 318-966-5438
Mailing address:
  • Phone: 318-966-5437
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP07983
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: