Provider Demographics
NPI:1255153185
Name:GRAY, TERESA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
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 1:219 CRAIGO CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9230
Mailing Address - Country:US
Mailing Address - Phone:618-727-3274
Mailing Address - Fax:
Practice Address - Street 1:47 FISHERMAN LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5013
Practice Address - Country:US
Practice Address - Phone:855-390-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56097164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse