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General NPI Number Information
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NPI Number | 1548981368
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Entity Type | Individual
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Provider Name | KATELYNN MARIE GRAY CNP
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 2805 5TH ST
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City | RAPID CITY
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State | SD
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Zip | 57701-6003
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Country | US
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Telephone | 605-755-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 13959 TELLURIDE ST
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City | SUMMERSET
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State | SD
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Zip | 57769-6207
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Country | US
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Telephone | 605-431-0218
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP002506
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License Number State | SD
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