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General NPI Number Information
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NPI Number | 1447895289
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Entity Type | Individual
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Provider Name | VANESSA MUKASOLU ECHETABU GRAY PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 1430 EMPIRE CENTRAL DR FL 1
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City | DALLAS
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State | TX
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Zip | 75247-4032
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Country | US
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Telephone | 214-645-8500
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Fax | 214-648-3775
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Provider Business Mailing Address
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Address Line | 5353 HARRY HINES BLVD # 9070
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City | DALLAS
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State | TX
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Zip | 75390-9070
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Country | US
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Telephone | 214-645-8500
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Fax | 214-648-1417
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP143630
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License Number State | TX
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