Healthcare Provider Details

I. General information

NPI: 1124922984
Provider Name (Legal Business Name): KRISTINA KEALOHA GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 SYLVANIA AVE
SYLVANIA OH
43560-3532
US

IV. Provider business mailing address

7225 SYLVANIA AVE
SYLVANIA OH
43560-3532
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-8696
  • Fax: 419-824-8608
Mailing address:
  • Phone: 419-824-8696
  • Fax: 419-824-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberRN495925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: