Provider Demographics
NPI:1073287520
Name:MADRIGAL GRAY, KARLA (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:MADRIGAL GRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825-7239
Mailing Address - Country:US
Mailing Address - Phone:423-919-8244
Mailing Address - Fax:423-919-8245
Practice Address - Street 1:402 S BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-7239
Practice Address - Country:US
Practice Address - Phone:423-919-8244
Practice Address - Fax:423-919-8245
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TN5623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical