Provider Demographics
NPI:1306504089
Name:GRAY, JAMEON KOVON
Entity type:Individual
Prefix:
First Name:JAMEON
Middle Name:KOVON
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 BENNING RD NE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4546
Mailing Address - Country:US
Mailing Address - Phone:202-749-2277
Mailing Address - Fax:
Practice Address - Street 1:1035 4TH ST NW APT 902
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3589
Practice Address - Country:US
Practice Address - Phone:301-213-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion