Provider Demographics
NPI:1386625762
Name:GRAYSON, NANCY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25353 E 840 RD
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-5818
Mailing Address - Country:US
Mailing Address - Phone:918-808-3306
Mailing Address - Fax:888-504-7682
Practice Address - Street 1:25353 E 840 RD
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-5818
Practice Address - Country:US
Practice Address - Phone:918-808-3306
Practice Address - Fax:888-504-7682
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1117590Medicaid
OKC68946Medicare UPIN