Active NPI
Amanda Wallace Gray
- Psychologist
- Butner, NC
National Provider Identifier
1306345848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6407
- Practice address
- 300 Veazey Dr
Butner, NC 27509-1668 - Phone
- (919) 764-5543
- NPI assigned
- Feb 11, 2018
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6407 | NC | Primary |
Addresses
Primary practice location
300 Veazey Dr
Butner, NC 27509-1668
Mailing address
300 Veazey Dr
Butner, NC 27509-1668
Phone (919) 764-5543
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 |
|---|---|---|---|
| 6407 | NC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733443200000",
"number": "1306345848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 VEAZEY DR",
"city": "BUTNER",
"state": "NC",
"postal_code": "275091668",
"telephone_number": "919-764-5543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 VEAZEY DR",
"city": "BUTNER",
"state": "NC",
"postal_code": "275091668",
"telephone_number": "919-764-5543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "AMANDA",
"middle_name": "WALLACE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-11",
"last_updated": "2024-12-06",
"certification_date": "2024-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "6407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Butner, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.