Provider Demographics
NPI:1053437897
Name:GRAY, JO (ARNP)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:OVERHOUSE-GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 84353
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5653
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 640
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-646-4700
Practice Address - Fax:425-646-1076
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00064876163W00000X
WAAP30002151363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8128084Medicaid
WA8128084Medicaid