Healthcare Provider Details

I. General information

NPI: 1205749165
Provider Name (Legal Business Name): ELIZABETH PATTERSON GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 TERRY RD
SOMERVILLE TN
38068-5790
US

IV. Provider business mailing address

535 TERRY RD
SOMERVILLE TN
38068-5790
US

V. Phone/Fax

Practice location:
  • Phone: 601-969-2440
  • Fax:
Mailing address:
  • Phone: 901-859-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number283014
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: