Healthcare Provider Details

I. General information

NPI: 1487582748
Provider Name (Legal Business Name): GRAY SKIES WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N MAIN ST
WALNUT COVE NC
27052
US

IV. Provider business mailing address

3000 BETHESDA PL STE 5031050
WINSTON SALEM NC
27103-3331
US

V. Phone/Fax

Practice location:
  • Phone: 336-310-5095
  • Fax:
Mailing address:
  • Phone: 336-310-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LATONYA GRAY
Title or Position: OWNER, PROVIDER
Credential: DNP, PMHNP-BC
Phone: 336-310-5095