Provider Demographics
NPI:1679769129
Name:GRAY, LAURA SCOTT (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SCOTT
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MUELLER BRASS RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3754
Mailing Address - Country:US
Mailing Address - Phone:901-476-0235
Mailing Address - Fax:901-476-0229
Practice Address - Street 1:4700 MUELLER BRASS RD.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-8323
Practice Address - Country:US
Practice Address - Phone:901-476-0235
Practice Address - Fax:901-476-0229
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN62937164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse