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General NPI Number Information
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NPI Number | 1144060393
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Entity Type | Individual
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Provider Name | LATONYA SHARI GRAY DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 125 ASHLEYBROOK SQ
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3111
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Country | US
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Telephone | 336-765-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 125 ASHLEYBROOK SQ
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3111
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Country | US
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Telephone | 336-765-6577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 207095
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5021393
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License Number State | NC
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