Healthcare Provider Details

I. General information

NPI: 1336898063
Provider Name (Legal Business Name): VALERIE LOUISE GRAY NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

653 JEFFERSON AVE # E206
MEMPHIS TN
38105-4911
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5437
  • Fax:
Mailing address:
  • Phone: 901-448-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1073139
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1073139
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number37331
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number37331
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: