Provider Demographics
NPI:1780920553
Name:GRAY, MEGHAN ELIZABETH (NP)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:ELIZABETH
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 1:29 MOSS WOODS CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9164
Mailing Address - Country:US
Mailing Address - Phone:601-720-6800
Mailing Address - Fax:
Practice Address - Street 1:1963 MCDOWELL ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39296
Practice Address - Country:US
Practice Address - Phone:601-372-3632
Practice Address - Fax:601-372-7361
Is Sole Proprietor?:No
Enumeration Date:2012-12-22
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily