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General NPI Number Information
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NPI Number | 1629448956
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Entity Type | Individual
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Provider Name | LEANDRA JORDAN GRAY NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 51 S STANFIELD RD
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City | TROY
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State | OH
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Zip | 45373-2992
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Country | US
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Telephone | 937-335-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 3170 KETTERING BLVD BLDG B3
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City | MORAINE
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State | OH
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Zip | 45439-1924
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Country | US
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Telephone | 937-991-3189
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Fax | 931-223-9811
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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 | 18185
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License Number State | OH
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