Provider Demographics
NPI:1174821870
Name:GRAY, JUDY KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:KAY
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23411 TEAK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3259
Mailing Address - Country:US
Mailing Address - Phone:573-336-4584
Mailing Address - Fax:
Practice Address - Street 1:210 MISSOURI AVE
Practice Address - Street 2:CTMC
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65573
Practice Address - Country:US
Practice Address - Phone:573-596-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO046367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse