Individual
JENNIFER LETICIA GRAYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
147 REYNOIR ST STE 202, BILOXI, MS 39530-4109
(228) 594-8000
(228) 594-8002
Mailing address
POST OFFICE BOX 6579, D'IBERVILLE, MS 39540
(228) 594-8000
(228) 594-8002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
17609
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125565
—
MS
01
—
680498058
BLUE CROSS/ BLUE SHIELD
MS
Enumeration date
08/24/2006
Last updated
02/19/2015
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