Laura Gray, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

236320 Issued in AZ

Practice address

1000 Willow Creek Rd Ste a
Prescott, AZ 86301-1645

Phone

(928) 460-9866

Fax

(928) 259-2885

NPI assigned

Jan 10, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Laura D Wallace Former name

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Exceptional Physicians Group Arizona PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Maricopa, AZ
  • NPI 1447910229
  Medicare reassignment NPD
• Exceptional Physicians Group Bullhead City Hospital PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bullhead City, AZ
  • NPI 1518732023
  Medicare reassignment NPD
• Exceptional Physicians Group Prescott Hospital PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Prescott, AZ
  • NPI 1720807670
  Medicare reassignment NPD
• Exceptional Physicians Group Yuma Hospital PLLC

  • Emergency Medicine Physician
  • Yuma, AZ
  • NPI 1235857699
  Medicare reassignment NPD
• Exceptional Health Care Bullhead City LLC

  dba Exceptional Community Hospital Bullhead City

  • Special Hospital
  • Bullhead City, AZ
  • NPI 1750092110
  NPD (past)
• Exceptional Health Care Maricopa LLC

  dba Exceptional Community Hospital Maricopa

  • Special Hospital
  • Maricopa, AZ
  • NPI 1518539048
  NPD (past)
• Exceptional Health Care Prescott LLC

  • Special Hospital
  • Prescott, AZ
  • NPI 1396452108
  NPD (past)

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

{
    "created_epoch": "1578614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1902446503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4235",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863024235",
            "telephone_number": "928-460-9866",
            "fax_number": "928-259-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WILLOW CREEK RD STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011645",
            "telephone_number": "928-460-9866",
            "fax_number": "928-259-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "LAURA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-10",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "236320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "WALLACE",
            "middle_name": "D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Granite Orthopaedics, PLLC
• Granite View Adult Care Home LLC
• April Gray, LMSW
• Dee Gray, LCSW
• Jennifer Diane Gray, LCSW
• Paulina Gray
• David Andrew Green, M.D.
• Kristina Diane Green, APRN,FNP-C
• Lance David Green, DDS
• Stephen Green, PA-C

• Nurse Practitioner in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.