Tracey Grayer, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

905260 Issued in MS

Practice address

3502 W Northside Dr
Jackson, MS 39213-4454

Phone

(601) 362-5321

Fax

(601) 364-5159

NPI assigned

Aug 23, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Central Mississippi Civic Improvement Association, Inc

  dba Jackson Hinds Comprehensiv Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1134151442
  Medicare reassignment NPD
• Central Mississippi Civic Improvement Association, Inc.

  dba Jackson Hinds Comprehensive Health Center Unit 7

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1215744396
  NPD

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1336868371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 545",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391300545",
            "telephone_number": "770-546-6270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-362-5321",
            "fax_number": "601-364-5159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYER",
        "first_name": "TRACEY",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "905260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "desktops",
            "affiliation": "Y",
            "affiliationName": "Jackson Hinds Comprehensive Health Center",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3502 W Northside Dr",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392134454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Milinda Kay Gray
• Nicedriana Gray
• Rashaad Gray
• Rica Miller Gray, LPC, NCC, CRC
• Sandra Gray, RDH
• Destiny Grear
• Greater Jackson OBGYN LLC (Metro Jackson OBGYN)
• Greater Jackson Physician Group (Greater Jackson Physician Group, LLC)
• Green Behavioral Services, LLC
• Green Case Management Services

• Gerontology Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Gerontology Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.