Provider Demographics
NPI:1619490661
Name:GRAY, MISTI S (WHNP)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:S
Last Name:GRAY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16410 STEDHAM CIRCLE
Mailing Address - Street 2:APT 104
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025
Mailing Address - Country:US
Mailing Address - Phone:757-325-7255
Mailing Address - Fax:
Practice Address - Street 1:2296 OPTIZ BLVD, SUITE 440
Practice Address - Street 2:ABOUT WOMEN OB/GYN
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:703-878-3933
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024174967363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology