MEDICARE: MIKALYN GRAY

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.0039798	OH
2	163W00000X	Registered Nurse	RN.463196	OH

General Provider Information

NPI Number	:	1346042199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKALYN GRAY

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5141 W BROAD ST STE 130
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1984
Country	:	US
Telephone Number	:	614-851-8469
Fax Number	:

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

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	01/28/2026

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