Individual
JERRICA SUE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
204 S PEAKE ST, ARKADELPHIA, AR 71923-5534
(501) 353-5000
Mailing address
204 S PEAKE ST, ARKADELPHIA, AR 71923-5534
(501) 353-5000
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
934922977
DRIVER LISCENSE
AR
Enumeration date
03/12/2020
Last updated
03/12/2020
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