Provider Demographics
NPI:1558845222
Name:GRAY, KARA (APRN; NP-C; FNP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:APRN; NP-C; FNP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:BUSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4607 MACCORKLE AVE SW STE 406
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-766-4342
Mailing Address - Fax:304-766-3541
Practice Address - Street 1:4607 MACCORKLE AVE SW STE 406
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-766-4342
Practice Address - Fax:304-766-3541
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV79978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily