Provider Demographics
NPI:1194318568
Name:GRAY, BRIANA LYNN
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:LYNN
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 1:1202 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2307
Mailing Address - Country:US
Mailing Address - Phone:504-309-6798
Mailing Address - Fax:
Practice Address - Street 1:1202 MONROE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2307
Practice Address - Country:US
Practice Address - Phone:504-309-6798
Practice Address - Fax:504-407-2115
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator