Provider Demographics
NPI:1568776235
Name:GRAY, SUSAN SPICKARD (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SPICKARD
Last Name:GRAY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4035
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:615-250-9251
Practice Address - Street 1:393 WALLACE RD
Practice Address - Street 2:STE A400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4880
Practice Address - Country:US
Practice Address - Phone:615-331-8281
Practice Address - Fax:615-391-4491
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC162814163WE0003X, 363LA2200X
TNAPN19684363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency