Provider Demographics
NPI:1295318459
Name:GRAY, STEPHANIE D (RN,MSN, APRN-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN,MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-3912
Mailing Address - Country:US
Mailing Address - Phone:832-574-5570
Mailing Address - Fax:
Practice Address - Street 1:108 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-3912
Practice Address - Country:US
Practice Address - Phone:832-574-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740045163WP0807X, 163WP0808X
TX1039298363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health