Provider Demographics
NPI:1245753656
Name:GRAY, RICHARD (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S COLONY WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6972
Mailing Address - Country:US
Mailing Address - Phone:907-290-3603
Mailing Address - Fax:907-931-6379
Practice Address - Street 1:634 S BAILEY ST STE 201
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6360
Practice Address - Country:US
Practice Address - Phone:907-290-3603
Practice Address - Fax:907-931-6379
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVTAPRN701646363LP0808X
NVAPRN002619363LP0808X
AK132337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health