Provider Demographics
NPI:1033643721
Name:GRAY, JASMINE TREMELL (DO)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:TREMELL
Last Name:GRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1073
Mailing Address - Country:US
Mailing Address - Phone:859-396-7128
Mailing Address - Fax:
Practice Address - Street 1:10032 DEMIA WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4734
Practice Address - Country:US
Practice Address - Phone:859-647-6700
Practice Address - Fax:859-372-6362
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KYTP936208000000X
MI5101025694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty