Kelly B Gray, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

2642-C Issued in AR

Practice address

1233 W Poplar St
Rogers, AR 72756-4245

Phone

(479) 636-9235

Fax

(479) 631-0374

NPI assigned

Jun 8, 2009

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

Other names 1

• Kelly B Reed Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349395200000",
    "number": "1346476165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVE STE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 W POPLAR ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727564245",
            "telephone_number": "479-636-9235",
            "fax_number": "479-631-0374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "KELLY",
        "middle_name": "B",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-08",
        "last_updated": "2012-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "2642-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177258795",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5AC40",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "REED",
            "middle_name": "B",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Corey Kendall Graham, PT
• Alexa Blaire Grand, PA-C
• Phebe Joy Granderson, CNM
• Grant J Fowler D.D.S.
• Patrick Michael Grant Jr.
• Rachel Gray
• Green Acre Easy Lliving
• Brian Charles Green, OT
• Erin Caldwell Green
• Gary Lane Green, MS, LPC, LMFT

• Social Worker in Rogers, AR
• Providers in Rogers, AR by specialty
• Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.