MEDICARE: TRACI GRAY AGNP-C

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	363LA2200X	Adult Health Nurse Practitioner	206362	LA
2	363LP2300X	Primary Care Nurse Practitioner	206362	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831759547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI GRAY AGNP-C

Provider Business Mailing Address
First Line	:	307 CARPENTER ST
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-7143
Country	:	US
Telephone Number	:	318-481-5724
Fax Number	:	318-257-1468

Provider Business Practice Location Address
First Line	:	307 CARPENTER ST
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-7143
Country	:	US
Telephone Number	:	318-481-5724
Fax Number	:	318-257-1468

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	12/18/2025

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