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General NPI Number Information
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NPI Number | 1689479321
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Entity Type | Individual
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Provider Name | ERIN CANNON GRAY CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 105 PAVILION WAY
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-4556
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Country | US
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Telephone | 910-692-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 260 SANDHILLS CIR
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City | PINEHURST
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State | NC
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Zip | 28374-7032
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Country | US
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Telephone | 714-423-5213
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5021678
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License Number State | NC
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