Healthcare Provider Details

I. General information

NPI: 1407768732
Provider Name (Legal Business Name): TAMMY L GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 DAVIS BLVD STE 102
KELLER TX
76248-0309
US

IV. Provider business mailing address

8725 DAVIS BLVD STE 102
KELLER TX
76248-0309
US

V. Phone/Fax

Practice location:
  • Phone: 817-729-9840
  • Fax:
Mailing address:
  • Phone: 817-729-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number729228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: