Healthcare Provider Details

I. General information

NPI: 1285571190
Provider Name (Legal Business Name): LATERRICA GRAY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAIN ST STE 1
COLLINS MS
39428-6188
US

IV. Provider business mailing address

200 MAIN ST STE 1
COLLINS MS
39428-6188
US

V. Phone/Fax

Practice location:
  • Phone: 601-543-8974
  • Fax: 601-653-9684
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License NumberRCP1540
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: