Healthcare Provider Details

I. General information

NPI: 1508785049
Provider Name (Legal Business Name): NATALIE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 ACCOMAC ST
SAINT LOUIS MO
63104-2217
US

IV. Provider business mailing address

2621 ACCOMAC ST
SAINT LOUIS MO
63104-2217
US

V. Phone/Fax

Practice location:
  • Phone: 217-521-8956
  • Fax:
Mailing address:
  • Phone: 217-521-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026032438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: