Provider Demographics
NPI:1922698265
Name:GRAY, JESSICA K
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14107 ELKINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5752
Mailing Address - Country:US
Mailing Address - Phone:804-212-9685
Mailing Address - Fax:
Practice Address - Street 1:3800 FESTIVAL PARK PLZ APT 216
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4461
Practice Address - Country:US
Practice Address - Phone:804-212-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty