Healthcare Provider Details

I. General information

NPI: 1497287304
Provider Name (Legal Business Name): ROSEANN TAYLOR GRAY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ROSEANN TAYLOR FISHER

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W LOCUST ST
LAFAYETTE TN
37083-1710
US

IV. Provider business mailing address

207 W LOCUST ST
LAFAYETTE TN
37083-1710
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone: 615-699-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014497
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000022200
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: