Provider Demographics
NPI:1831950120
Name:GRAY, KEDRICK MARKEITH
Entity type:Individual
Prefix:
First Name:KEDRICK
Middle Name:MARKEITH
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ALEX WAY
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7119
Mailing Address - Country:US
Mailing Address - Phone:318-691-2221
Mailing Address - Fax:
Practice Address - Street 1:625 ALEX WAY
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-7119
Practice Address - Country:US
Practice Address - Phone:318-691-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker