Provider Demographics
NPI:1790001469
Name:GRAY, LINDSEY R (MSN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2617
Mailing Address - Country:US
Mailing Address - Phone:423-224-3950
Mailing Address - Fax:423-224-3959
Practice Address - Street 1:4600 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2617
Practice Address - Country:US
Practice Address - Phone:423-224-3950
Practice Address - Fax:423-224-3959
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14927363LF0000X
VA0024169595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520644Medicaid
VA1790001469Medicaid
VAVV4044AMedicare PIN
VA1790001469Medicaid
TN10350I3539Medicare PIN
C09112Medicare UPIN