Provider Demographics
NPI:1497287304
Name:GRAY, ROSEANN TAYLOR (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ROSEANN
Middle Name:TAYLOR
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MISS
Other - First Name:ROSEANN
Other - Middle Name:TAYLOR
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 DALE ST
Mailing Address - Street 2:
Mailing Address - City:RED BOILING SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37150-2102
Mailing Address - Country:US
Mailing Address - Phone:615-699-3169
Mailing Address - Fax:
Practice Address - Street 1:165 DALE ST
Practice Address - Street 2:
Practice Address - City:RED BOILING SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37150-2102
Practice Address - Country:US
Practice Address - Phone:615-699-3169
Practice Address - Fax:615-666-3022
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014497363LF0000X
TNAPN0000022200363LF0000X
TN22200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030943Medicaid
TNQ030943Medicaid