Provider Demographics
NPI:1174678395
Name:GRAY, JASON DE-LEON (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DE-LEON
Last Name:GRAY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5599 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2866
Mailing Address - Country:US
Mailing Address - Phone:985-857-3615
Mailing Address - Fax:985-857-3765
Practice Address - Street 1:5599 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2866
Practice Address - Country:US
Practice Address - Phone:985-857-3615
Practice Address - Fax:985-857-3765
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN120214163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN120214OtherRN LICENSE NUMBER