Provider Demographics
NPI:1093808982
Name:GRAYSON, PATRICIA A (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11590 N MERIDIAN ST
Practice Address - Street 2:STE 300
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4529
Practice Address - Country:US
Practice Address - Phone:317-948-7450
Practice Address - Fax:317-688-5098
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28127287A363LP0200X
IN71002039363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200833890Medicaid
INQ76069Medicare UPIN
INM400064670Medicare PIN
IN200833890Medicaid