Healthcare Provider Details

I. General information

NPI: 1568776235
Provider Name (Legal Business Name): SUSAN SPICKARD GRAY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 WALLACE RD STE A400
NASHVILLE TN
37211-4880
US

IV. Provider business mailing address

2801 CHARLOTTE AVE
NASHVILLE TN
37209-4035
US

V. Phone/Fax

Practice location:
  • Phone: 615-331-8281
  • Fax: 615-391-4491
Mailing address:
  • Phone: 615-250-9200
  • Fax: 615-250-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number162814
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number162814
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN19684
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: