Provider Demographics
NPI:1679252746
Name:BRAY, CRISTIANA GRESHAM
Entity Type:Individual
Prefix:
First Name:CRISTIANA
Middle Name:GRESHAM
Last Name:BRAY
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 1:11850 JOURNEYS END TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2380
Mailing Address - Country:US
Mailing Address - Phone:919-323-1565
Mailing Address - Fax:
Practice Address - Street 1:201 DALE EARNHARDT BLVD STE 201
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-0308
Practice Address - Country:US
Practice Address - Phone:704-403-7430
Practice Address - Fax:704-403-7431
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019465363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics