Mallory Jo Gray, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

87735 Issued in OK

Practice address

400 N Eastern Ave
Moore, OK 73160-5833

Phone

(405) 730-6990

Fax

(405) 730-6992

NPI assigned

Feb 7, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Your Health LLCGroup PAC ID 3870922008, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mgray@jkp.gwaydirect.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.973232

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Your Health LLC

  dba Your Health & Wellness

  • Family Medicine Physician
  • Moore, OK
  • NPI 1396385431
  Medicare reassignment Care Compare group NPD
• Aky MD, LLC

  dba Just Kids Pediatrics

  • Pediatrics Physician
  • Moore, OK
  • NPI 1063846699
  NPD (past)
• Norman Regional Hospital Authority

  dba Norman Regional

  • General Acute Care Hospital
  • Norman, OK
  • NPI 1700882578
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1255963252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 891625",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731891625",
            "telephone_number": "405-757-7818",
            "fax_number": "405-703-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N EASTERN AVE",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731605833",
            "telephone_number": "405-730-6990",
            "fax_number": "405-730-6992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Eastern Ave",
            "address_purpose": "LOCATION",
            "city": "Moore",
            "state": "OK",
            "postal_code": "731605833",
            "country_code": "US",
            "telephone_number": "405-757-7818",
            "fax_number": "405-703-3116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "MALLORY",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-07",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "87735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200905610A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1B6545",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Audrey Louise Graham
• Aumony Janaya Grate
• Deborah A Gray, LPC
• Hannah Laree Gray
• Laurence Burton Gray Jr.
• Kasey Cory Green
• Katherine Denice Green
• Lexus Green
• Lori Beth Greene, PHARMD
• Matthew Greenroyd, M.P.T.

• Family Nurse Practitioner in Moore, OK
• Providers in Moore, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.