KATHLEEN E GRAY ARNP NPI 1124393418

NPI Information

  • NPI: 1124393418
  • Provider Name: KATHLEEN E GRAY, ARNP
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1636 SHADOWOOD LN STE 120
    JACKSONVILLE, FL
    ZIP 32207
  • Phone: (904) 725-9701

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NPI Details

Kathleen E Gray, ARNP is a psychiatric/mental health nurse practitioner in Jacksonville, FL. Kathleen E Gray, ARNP NPI is 1124393418. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1636 SHADOWOOD LN STE 120
JACKSONVILLE, FL
ZIP 32207-187
Phone: (904) 725-9701
Fax: (904) 725-9694

The NPI 1124393418 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/20/2012 and was last updated on 2/16/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental HealthARNP2844802FLORIDANo
2363LP0808XNurse PractitionerPsychiatric/Mental HealthARNP2844802FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17663463MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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