Healthcare Provider Details

I. General information

NPI: 1013416577
Provider Name (Legal Business Name): BRYAN GRAY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HUFFMAN MILL RD
BURLINGTON NC
27215
US

IV. Provider business mailing address

1240 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

V. Phone/Fax

Practice location:
  • Phone: 336-586-3935
  • Fax: 336-538-7045
Mailing address:
  • Phone: 336-586-3935
  • Fax: 336-538-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number214364
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010274
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: