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General NPI Number Information
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NPI Number | 1467374363
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Entity Type | Individual
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Provider Name | KAITLYN ROSE GRAY
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 3211 PROVIDENCE DR # DRIVE211
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City | ANCHORAGE
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State | AK
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Zip | 99508-4614
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Country | US
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Telephone | 907-786-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 PICKERING DR
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City | FAIRBANKS
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State | AK
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Zip | 99709-5765
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Country | US
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Telephone | 907-378-6473
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 213178
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License Number State | AK
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