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General NPI Number Information
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NPI Number | 1477358398
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Entity Type | Individual
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Provider Name | ZACKREY LEE GRAY CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 5735 COLLEGE PKWY
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City | MOBILE
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State | AL
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Zip | 36613-2842
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Country | US
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Telephone | 251-442-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 151 DU RHU DR APT 2407
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City | MOBILE
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State | AL
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Zip | 36608-1274
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Country | US
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Telephone | 205-243-9595
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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 | 1-142092
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2671674
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-142092
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License Number State | AL
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