Provider Demographics
NPI:1821328949
Name:GRAY, JOUVONNA LYNETTE (FNP)
Entity Type:Individual
Prefix:
First Name:JOUVONNA
Middle Name:LYNETTE
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 W LAKE HOUSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5131
Mailing Address - Country:US
Mailing Address - Phone:281-812-3736
Mailing Address - Fax:844-781-2056
Practice Address - Street 1:19020 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5131
Practice Address - Country:US
Practice Address - Phone:281-812-3736
Practice Address - Fax:844-781-2056
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127938363LF0000X
TX722565163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3514549-02Medicaid