Provider Demographics
NPI:1710287511
Name:GRAY, DEBORAH T (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:T
Last Name:GRAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W.ESPLANADE AVE.
Mailing Address - Street 2:MINUTECLINIC
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-467-8313
Mailing Address - Fax:
Practice Address - Street 1:7725 EDWARD ST
Practice Address - Street 2:MINUTECLINIC 820 W.ESPLANADE AVE. KENNER LA 70065
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1925
Practice Address - Country:US
Practice Address - Phone:504-246-7107
Practice Address - Fax:504-246-7107
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN053134-AP02492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2009012139OtherAMERICAN NURSES CREDENTIALING CENTER
LA2132237Medicaid