Provider Demographics
NPI:1912644469
Name:GRAY, YOLANDA NADINE
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:NADINE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
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 78820
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-8820
Mailing Address - Country:US
Mailing Address - Phone:615-424-8758
Mailing Address - Fax:615-649-8287
Practice Address - Street 1:2417 GARDNER LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-4201
Practice Address - Country:US
Practice Address - Phone:615-424-8758
Practice Address - Fax:615-649-8287
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
TNL0000000300023104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No253Z00000XAgenciesIn Home Supportive Care