Individual
DESTINY A RUSSELL GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1200 E BROAD ST, RICHMOND, VA 23298-5025
(804) 628-9346
Mailing address
1250 E MARSHALL ST, RICHMOND, VA 23298-5023
(804) 828-9000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024189353
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN-4042
HI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
GAA-NP000748
GA
Other
Enumeration date
06/02/2022
Last updated
02/19/2026
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