Provider Demographics
NPI:1992248249
Name:GRAY, CHIRISE (AGNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHIRISE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:AGNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 KEWANEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7048
Mailing Address - Country:US
Mailing Address - Phone:888-622-6755
Mailing Address - Fax:
Practice Address - Street 1:2110 N WILLIS ST, SUITE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603
Practice Address - Country:US
Practice Address - Phone:325-232-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132622363LA2200X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology