Individual
MRS. MALLORY JO GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
400 N EASTERN AVE, MOORE, OK 73160-5833
(405) 730-6990
(405) 730-6992
Mailing address
PO BOX 891625, OKLAHOMA CITY, OK 73189-1625
(405) 757-7818
(405) 703-3116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
87735
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1B6545
MEDICARE PTAN
OK
05
—
200905610A
—
OK
Enumeration date
02/07/2020
Last updated
09/07/2023
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