Provider Demographics
NPI:1639194012
Name:GRAY, DEANNA S (NP)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:S
Last Name:GRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 PRUE RD, BUILDING 1
Mailing Address - Street 2:STE 100C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1161
Mailing Address - Country:US
Mailing Address - Phone:210-750-8100
Mailing Address - Fax:
Practice Address - Street 1:5253 PRUE RD, BUILDING 1
Practice Address - Street 2:STE 100C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1758
Practice Address - Country:US
Practice Address - Phone:210-750-8100
Practice Address - Fax:210-750-8101
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125708363LF0000X
NC201859363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX847275Medicaid
00007OtherBC
NC3406870OtherAMBULANCE MEDICAID
NC562014989OtherTRICARE
NC3406870OtherAMBULANCE MEDICAID
NC2592451CMedicare PIN