Active NPI
Charleston Gray
- Emergency Registered Nurse
- Gallup, NM
National Provider Identifier
1780119735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Registered Nurse
- License
- 771013
- Practice address
- 516 E. Nizhoni Blvd
Gallup Indian Medical Center
Gallup, NM 87301 - Phone
- (505) 722-1000
- NPI assigned
- Apr 27, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 771013 | CA | Primary |
Addresses
Primary practice location
516 E. Nizhoni Blvd
Gallup Indian Medical Center
Gallup, NM 87301
Mailing address
516 E. Nizhoni Blvd
Gallup Indian Medical Center
Gallup, NM 87301
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 771013 | CA | MD | Emergency Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493251200000",
"number": "1780119735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "516 E. NIZHONI BLVD",
"address_2": "GALLUP INDIAN MEDICAL CENTER",
"city": "GALLUP",
"state": "NM",
"postal_code": "87301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 E. NIZHONI BLVD",
"address_2": "GALLUP INDIAN MEDICAL CENTER",
"city": "GALLUP",
"state": "NM",
"postal_code": "87301",
"telephone_number": "505-722-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "CHARLESTON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-27",
"last_updated": "2017-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "CA",
"license": "771013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.