Healthcare Provider Details

I. General information

NPI: 1669889457
Provider Name (Legal Business Name): HANNAH GRAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BIRCH ST
DE KALB MS
39328-8017
US

IV. Provider business mailing address

2701 DAVIS ST
MERIDIAN MS
39301-5708
US

V. Phone/Fax

Practice location:
  • Phone: 601-743-2643
  • Fax: 601-553-8175
Mailing address:
  • Phone: 601-693-0118
  • Fax: 601-553-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR882611
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: