Provider Demographics
NPI:1386517613
Name:GRAYER PROFESSIONAL NURSING SERVICES
Entity type:Organization
Organization Name:GRAYER PROFESSIONAL NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRENILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:601-754-5513
Mailing Address - Street 1:747 INDUSTRIAL PARK RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2065
Mailing Address - Country:US
Mailing Address - Phone:601-754-5513
Mailing Address - Fax:
Practice Address - Street 1:4211 NW HIGHWAY 550
Practice Address - Street 2:
Practice Address - City:UNION CHURCH
Practice Address - State:MS
Practice Address - Zip Code:39668-7012
Practice Address - Country:US
Practice Address - Phone:601-754-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty