Active NPI
Shelly Ann Gray, CMA
- Nurse's Aide
- Newport, OR
National Provider Identifier
1619729613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 728012
- Practice address
- 36 SW Nye St
Newport, OR 97365-3821 - Phone
- (541) 265-4947
- NPI assigned
- Apr 3, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 728012 | OR | Primary |
Addresses
Primary practice location
36 SW Nye St
Newport, OR 97365-3821
Mailing address
21621 Logsden Rd
Blodgett, OR 97326-9343
Phone (503) 451-1969
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
- Certified Medical Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 728012 | OR | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740614400000",
"number": "1619729613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21621 LOGSDEN RD",
"city": "BLODGETT",
"state": "OR",
"postal_code": "973269343",
"telephone_number": "503-451-1969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 SW NYE ST",
"city": "NEWPORT",
"state": "OR",
"postal_code": "973653821",
"telephone_number": "541-265-4947"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "SHELLY",
"middle_name": "ANN",
"credential": "CMA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-03",
"last_updated": "2025-02-27",
"certification_date": "2025-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "OR",
"license": "728012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.