Provider Demographics
NPI:1104468560
Name:GRAY, CHRISTOPHER (NP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GRAY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E 13TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2976
Mailing Address - Country:US
Mailing Address - Phone:918-786-9009
Mailing Address - Fax:405-951-9921
Practice Address - Street 1:900 E 13TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2976
Practice Address - Country:US
Practice Address - Phone:918-786-9009
Practice Address - Fax:405-951-9921
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK134650363LF0000X
OKR0134650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily