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General NPI Number Information
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NPI Number | 1790349462
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Entity Type | Individual
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Provider Name | MRS. NICOLE GRAY
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Gender | Female
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Dates
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Enumeration Date | 04/27/2019
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 3103 HOLIDAY DR
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City | WHITE HALL
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State | AR
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Zip | 71602-9559
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Country | US
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Telephone | 870-413-9528
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Fax | 870-541-6434
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Provider Business Mailing Address
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Address Line | 4201 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7016
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Country | US
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Telephone | 870-541-8654
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Fax | 870-541-6434
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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 | A006211
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License Number State | AR
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