Provider Demographics
NPI:1720380165
Name:GRAY, EMALINE (CAC)
Entity Type:Individual
Prefix:MRS
First Name:EMALINE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W MAIN ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-1840
Mailing Address - Country:US
Mailing Address - Phone:502-330-4233
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:SUITE 609
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1840
Practice Address - Country:US
Practice Address - Phone:502-330-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTAC49171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist