Provider Demographics
NPI:1912477506
Name:GRAY, LINDEN (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDEN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:LINDY
Other - Middle Name:
Other - Last Name:RUCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-778-3675
Mailing Address - Fax:307-632-3302
Practice Address - Street 1:5416 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4094
Practice Address - Country:US
Practice Address - Phone:307-778-3675
Practice Address - Fax:307-632-3302
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY27776.1836363L00000X
WY1836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner