Provider Demographics
NPI:1992258826
Name:GRAY, CHRISTIN (NP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3034
Mailing Address - Country:US
Mailing Address - Phone:731-784-4300
Mailing Address - Fax:731-784-4308
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3034
Practice Address - Country:US
Practice Address - Phone:731-784-4300
Practice Address - Fax:731-784-4308
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily