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NPI Code Detail

MEDICARE: KATHLEEN GRAY CRNP

MEDICARE: KATHLEEN GRAY CRNP
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
1363LF0000XFamily Nurse PractitionerSP006571BPA

General Provider Information

NPI Number : 1346331048
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN GRAY CRNP
Provider Business Mailing Address
First Line : 801 OSTRUM ST
Second Line :
City : BETHLEHEM
State : PA
Zip : 18015-1000
Country : US
Telephone Number : 845-266-0484
Fax Number :
Provider Business Practice Location Address
First Line : 2830 EASTON AVE
Second Line :
City : BETHLEHEM
State : PA
Zip : 18017-4204
Country : US
Telephone Number : 845-263-5554
Fax Number : 833-822-5230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/14/2021

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