Provider Demographics
NPI:1811556160
Name:GRAY, JASON GORDON (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GORDON
Last Name:GRAY
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 STATE LINE RD # 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3232
Mailing Address - Country:US
Mailing Address - Phone:816-363-2600
Mailing Address - Fax:816-523-0068
Practice Address - Street 1:9001 STATE LINE RD # 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3232
Practice Address - Country:US
Practice Address - Phone:816-363-2600
Practice Address - Fax:816-523-0068
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020038488363LF0000X
KS53-78788-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily