Individual
JODY GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12 S 8TH ST, YAKIMA, WA 98901-3020
(509) 454-4143
(509) 454-3651
Mailing address
PO BOX 719, SUNNYSIDE, WA 98944-0719
(509) 837-1602
(509) 837-4908
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60202580
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8899381
MEDICARE PTAN
—
Enumeration date
12/20/2010
Last updated
09/17/2015
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