Latisha Renee Gray, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703103631 Issued in MI

Practice address

4646 John R St
Detroit, MI 48201-1916

Phone

(313) 576-2472

NPI assigned

Jul 9, 2017

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1499558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1821510116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-2472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "LATISHA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-09",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703103631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "latisha.gray@va.gov",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4646 John R St",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482011916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gabrielle Gray
• Henry Gray
• Herman Gray, MD
• Katricia Gray
• Kimberly Gray
• Leslie R Gray
• Matthew Lynn Gray, D.D.S
• Olanah Gray, PHARMD, RPH
• Renardo Gray, R.PH.
• Rizpah Marie Gray

• Licensed Practical Nurse in Detroit, MI
• Providers in Detroit, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.