Provider Demographics
NPI:1669164935
Name:GRAY, TANIKA MICHELLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:MICHELLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-1336
Mailing Address - Country:US
Mailing Address - Phone:662-524-4347
Mailing Address - Fax:
Practice Address - Street 1:222 MARY HOLMES DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-4400
Practice Address - Country:US
Practice Address - Phone:662-524-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905999363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health