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General NPI Number Information
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NPI Number | 1366925158
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Entity Type | Individual
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Provider Name | ELIZABETH WALTERS GRAY DNP, AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2018
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 6060 PIEDMONT ROW DR S FL 10
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City | CHARLOTTE
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State | NC
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Zip | 28287-3893
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Country | US
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Telephone | 704-489-3094
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Fax |
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Provider Business Mailing Address
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Address Line | 5960 FAIRVIEW RD STE 500
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City | CHARLOTTE
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State | NC
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Zip | 28210-3113
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Country | US
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Telephone | 704-495-6324
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 5010956
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5010956
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License Number State | NC
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