Provider Demographics
NPI:1972389765
Name:GRAY, KRISTEN DOZIER (RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DOZIER
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 S HIGHWAY 501
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-8317
Mailing Address - Country:US
Mailing Address - Phone:843-289-0803
Mailing Address - Fax:
Practice Address - Street 1:1311 N MAIN ST # 102
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2010
Practice Address - Country:US
Practice Address - Phone:843-774-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC231584163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse