Healthcare Provider Details

I. General information

NPI: 1619825536
Provider Name (Legal Business Name): ASHLEY NICOLE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 304
ANNAPOLIS MD
21401-3745
US

IV. Provider business mailing address

3605 DORY BROOKS RD
CHESAPEAKE BEACH MD
20732-3865
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR228145
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: