Active NPI
Carla J Gray
- Long-Term Care Clinical Nurse Specialist
- Bedford, IN
National Provider Identifier
1205405016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long-Term Care Clinical Nurse Specialist
- License
- 28205916A
- Practice address
- 3100 Shawnee Dr S
Bedford, IN 47421-5287 - Phone
- (812) 675-4154
- NPI assigned
- Jun 24, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long-Term Care Clinical Nurse Specialist | 364SL0600X | 28205916A | IN | Primary |
Addresses
Primary practice location
3100 Shawnee Dr S
Bedford, IN 47421-5287
Mailing address
3100 Shawnee Dr S
Bedford, IN 47421-5287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28205916A | IN | MD | Long-Term Care Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624492800000",
"number": "1205405016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 SHAWNEE DR S",
"city": "BEDFORD",
"state": "IN",
"postal_code": "474215287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 SHAWNEE DR S",
"city": "BEDFORD",
"state": "IN",
"postal_code": "474215287",
"telephone_number": "812-675-4154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "CARLA",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-24",
"last_updated": "2021-06-24",
"certification_date": "2021-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "364SL0600X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Long-Term Care",
"state": "IN",
"license": "28205916A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bedford, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.