Individual provider Active NPI

Richard Lee Gray, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Charleston, WV
National Provider Identifier
1376392225
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
99336 Issued in WV
Practice address
1 Kenton Dr Ste 200
Charleston, WV 25311-1256
Phone
(304) 408-3292
NPI assigned
May 14, 2024
Last updated
May 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 99336 WV Primary

Addresses

Primary practice location

1 Kenton Dr Ste 200
Charleston, WV 25311-1256

Mailing address

201 Stone PL
Scott Depot, WV 25560-9466
Phone (304) 575-7877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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

Enrollment IDStateProvider typePAC IDDetails
I20240808004802 WV Practitioner - Nurse Practitioner 4385181247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Ohio State University College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grandw IncGroup PAC ID 9739324922, 93 clinicians

Practice addresses (Care Compare)

1 Kenton Dr
Suite 200
Charleston, WV 25311-1256
Phone (304) 460-5123

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
99336WVMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
GR&W, Inc CurrentSince Aug 5, 2024 Accepting new patients
GR&W, Inc PastSince May 19, 2024 Accepting new patients

Locations

1 Kenton Dr
Charleston, WV 25311
Phone (304) 205-9008

1 Kenton Dr
#200
Charleston, WV 25311
Phone (304) 408-3292

1005 White Willow Way
Morgantown, WV 26505
Phone (304) 212-7238

1100 Main St
Ste 104
Wheeling, WV 26003
Phone (304) 218-9405

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1376392225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 STONE PL",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609466",
            "telephone_number": "304-575-7877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KENTON DR STE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111256",
            "telephone_number": "304-408-3292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WV",
            "license": "99336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.