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General NPI Number Information
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NPI Number | 1801680301
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Entity Type | Individual
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Provider Name | KRISSA BROOKE GRAY APRN
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Gender | Female
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 2746 VIRGINIA AVE
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City | LOUISVILLE
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State | KY
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Zip | 40211-3417
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Country | US
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Telephone | 502-815-7040
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Fax |
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Provider Business Mailing Address
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Address Line | 133 RIDGEWOOD CT
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7500
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Country | US
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Telephone | 270-734-1712
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 1115652
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4039362
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License Number State | KY
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