Provider Demographics
NPI:1124385752
Name:GRAY, NICOLE K (PA)
Entity Type:Individual
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First Name:NICOLE
Middle Name:K
Last Name:GRAY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1431 CENTERPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1984
Mailing Address - Country:US
Mailing Address - Phone:865-539-8000
Mailing Address - Fax:865-985-7077
Practice Address - Street 1:601 DODDS AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3911
Practice Address - Country:US
Practice Address - Phone:423-453-8999
Practice Address - Fax:866-401-5838
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2023-06-12
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Provider Licenses
StateLicense IDTaxonomies
TNPA2161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant