MEDICARE: NIKIA D GRAYSON CNM DNP

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	22380	TN
2	367A00000X	Advanced Practice Midwife	236489	CA
3	367A00000X	Advanced Practice Midwife	22380	TN

General Provider Information

NPI Number	:	1417487935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKIA D GRAYSON CNM DNP

Provider Business Mailing Address
First Line	:	2356 SUTTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3006
Country	:	US
Telephone Number	:	415-353-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 SUTTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3006
Country	:	US
Telephone Number	:	415-353-3400
Fax Number	:

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

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	12/15/2025

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