Healthcare Provider Details

I. General information

NPI: 1124902606
Provider Name (Legal Business Name): FLORA DENISE GRAY HALEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FLORA DENISE GRAY

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 ELIZABETH CHAPMAN DR
JACKSON MS
39212-3252
US

IV. Provider business mailing address

2021 ELIZABETH CHAPMAN DR
JACKSON MS
39212-3252
US

V. Phone/Fax

Practice location:
  • Phone: 601-906-9680
  • Fax:
Mailing address:
  • Phone: 601-906-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907636
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: