Provider Demographics
NPI:1538337506
Name:GRAY, TARRA LEE (LMP)
Entity type:Individual
Prefix:MS
First Name:TARRA
Middle Name:LEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 JADWIN AVE STE J
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4244
Mailing Address - Country:US
Mailing Address - Phone:509-946-4800
Mailing Address - Fax:509-943-1270
Practice Address - Street 1:7411 W CLEARWATER AVE STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1683
Practice Address - Country:US
Practice Address - Phone:509-591-5874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019225175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath