Provider Demographics
NPI:1316626799
Name:GRAY, SARAH ELLEN (PMHNP-BC, DNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELLEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109B N TARVER AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2633
Mailing Address - Country:US
Mailing Address - Phone:615-509-4103
Mailing Address - Fax:
Practice Address - Street 1:109B N TARVER AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2633
Practice Address - Country:US
Practice Address - Phone:615-509-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN242929163WP0808X
TN14058205363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health