Provider Demographics
NPI:1831759547
Name:GRAY, TRACI TAYLOR (AGNP-C)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:TAYLOR
Last Name:GRAY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-7143
Mailing Address - Country:US
Mailing Address - Phone:318-481-5724
Mailing Address - Fax:318-257-1468
Practice Address - Street 1:307 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-7143
Practice Address - Country:US
Practice Address - Phone:318-481-5724
Practice Address - Fax:318-257-1468
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206362363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care