Provider Demographics
NPI:1619436433
Name:GRAY, KENDRA RACHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:RACHELLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2746
Mailing Address - Country:US
Mailing Address - Phone:606-528-9700
Mailing Address - Fax:
Practice Address - Street 1:57 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2746
Practice Address - Country:US
Practice Address - Phone:606-528-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05303208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics