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NPI Code Detail

MEDICARE: SANDRA LEE GRAY APRN

MEDICARE: SANDRA LEE GRAY APRN
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
1363LA2100XAcute Care Nurse Practitioner24708155AR

General Provider Information

NPI Number : 1588522718
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA LEE GRAY APRN
Provider Business Mailing Address
First Line : PO BOX 776084
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6084
Country : US
Telephone Number : 479-314-6030
Fax Number :
Provider Business Practice Location Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-314-6030
Fax Number : 479-314-2021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 05/11/2026

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