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Individual

ALAN GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CPNP-AC

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
1354 KIMWOOD DR, JACKSON, MS 39211-5913
(662) 701-7213

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
902933
MS
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
902933
MS

Other

Enumeration date
09/18/2018
Last updated
09/18/2018
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