MEDICARE: MRS. ANN M GRAY NP

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	89406APO4130	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	:	1922030634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN M GRAY NP

Provider Business Mailing Address
First Line	:	128 HERITAGE DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-1420
Country	:	US
Telephone Number	:	318-396-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	6198 CYPRESS ST BLDG 3
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9010
Country	:	US
Telephone Number	:	318-397-1616
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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