Provider Demographics
NPI:1629736186
Name:GREGSON, GARRY
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:GREGSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1446
Mailing Address - Country:US
Mailing Address - Phone:801-866-4107
Mailing Address - Fax:
Practice Address - Street 1:803 OAK AVE
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1446
Practice Address - Country:US
Practice Address - Phone:801-866-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8421241-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse