Provider Demographics
NPI:1598547820
Name:GRAY, TERANASIA KEORRA
Entity Type:Individual
Prefix:MS
First Name:TERANASIA
Middle Name:KEORRA
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 POINT ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4744
Mailing Address - Country:US
Mailing Address - Phone:985-851-4488
Mailing Address - Fax:
Practice Address - Street 1:723 POINT ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4744
Practice Address - Country:US
Practice Address - Phone:985-851-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant