Active NPI
Mallery Gray Gannaway, AA
- Athletic Trainer
- Oklahoma City, OK
National Provider Identifier
1306353685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 12301 N Macarthur Blvd Apt 304
Oklahoma City, OK 73142-3039 - Phone
- (405) 406-7112
- NPI assigned
- Jan 8, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 737 | OK | |
| Athletic Trainer | 2255A2300X | OK | Primary |
Addresses
Primary practice location
12301 N Macarthur Blvd Apt 304
Oklahoma City, OK 73142-3039
Mailing address
12301 N Macarthur Blvd Apt 304
Oklahoma City, OK 73142-3039
Phone (405) 406-7112
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
- Credentials
- Associate of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 737 | OK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515369600000",
"number": "1306353685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12301 N MACARTHUR BLVD APT 304",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731423039",
"telephone_number": "405-406-7112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12301 N MACARTHUR BLVD APT 304",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731423039",
"telephone_number": "405-406-7112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNAWAY",
"first_name": "MALLERY",
"middle_name": "GRAY",
"name_prefix": "Mrs.",
"credential": "AA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-08",
"last_updated": "2018-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "OK",
"license": "737",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OK",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.