Healthcare Provider Details

I. General information

NPI: 1053437897
Provider Name (Legal Business Name): JO GRAY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE OVERHOUSE-GRAY

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11232 NE 15TH ST STE 201
BELLEVUE WA
98004-3739
US

IV. Provider business mailing address

11232 NE 15TH ST STE 201
BELLEVUE WA
98004-3739
US

V. Phone/Fax

Practice location:
  • Phone: 425-646-4700
  • Fax: 425-646-1076
Mailing address:
  • Phone: 425-646-4700
  • Fax: 425-646-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30002151
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00064876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: