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NPI Code Detail

MEDICARE: STACY GRAY TCM

MEDICARE: STACY GRAY TCM
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
1171M00000XCase Manager/Care CoordinatorKY

General Provider Information

NPI Number : 1578414181
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY GRAY TCM
Provider Business Mailing Address
First Line : 611 FOREST AVE
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-1411
Country : US
Telephone Number : 606-564-4016
Fax Number : 606-564-0295
Provider Business Practice Location Address
First Line : 611 FOREST AVE
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-1411
Country : US
Telephone Number : 606-564-4016
Fax Number : 606-564-0295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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