Provider Demographics
NPI:1427391812
Name:GREY, RICHARD KYLE (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KYLE
Last Name:GREY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9546
Mailing Address - Country:US
Mailing Address - Phone:919-735-1400
Mailing Address - Fax:919-581-0353
Practice Address - Street 1:2280 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9546
Practice Address - Country:US
Practice Address - Phone:919-735-1400
Practice Address - Fax:919-581-0353
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant