MEDICARE: DR. LATONYA SHARI GRAY DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	207095	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5021393	NC

General Provider Information

NPI Number	:	1144060393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATONYA SHARI GRAY DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	125 ASHLEYBROOK SQ
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3111
Country	:	US
Telephone Number	:	336-765-6577
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 ASHLEYBROOK SQ
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3111
Country	:	US
Telephone Number	:	336-765-6577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	12/09/2025

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