Provider Demographics
NPI:1194511485
Name:GRAY, MEGAN MARIE (MA/ CHW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:
Credentials:MA/ CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 TIJERAS AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3062
Mailing Address - Country:US
Mailing Address - Phone:505-934-9506
Mailing Address - Fax:
Practice Address - Street 1:809 TIJERAS AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3062
Practice Address - Country:US
Practice Address - Phone:505-934-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator