Provider Demographics
NPI:1891908117
Name:GRAY, STEFANIE LEA (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:LEA
Last Name:GRAY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3309
Mailing Address - Country:US
Mailing Address - Phone:731-587-9511
Mailing Address - Fax:731-587-0785
Practice Address - Street 1:117 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3309
Practice Address - Country:US
Practice Address - Phone:731-587-9511
Practice Address - Fax:731-587-0785
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4157106OtherBLUE CROSS BLUE SHIELD
TN3341164Medicaid
TN3341164Medicare PIN