Provider Demographics
NPI:1114020062
Name:GRAY, KAREN L (RD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8259 SAINT JOHNS CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7407
Mailing Address - Country:US
Mailing Address - Phone:561-422-6381
Mailing Address - Fax:
Practice Address - Street 1:7305 N MILITARY TRAIL
Practice Address - Street 2:WPB VETERANS ADMINISTRATION: N&FS -#120
Practice Address - City:RIVIERIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6400
Practice Address - Country:US
Practice Address - Phone:561-422-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND-0002807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered