Provider Demographics
NPI:1639056757
Name:GRAY, KIERAN E B (PSS)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:E B
Last Name:GRAY
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSS
Mailing Address - Street 1:11480 SE STEVENS RD UNIT 411
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7639
Mailing Address - Country:US
Mailing Address - Phone:806-333-9693
Mailing Address - Fax:
Practice Address - Street 1:11480 SE STEVENS RD UNIT 411
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7639
Practice Address - Country:US
Practice Address - Phone:806-333-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist