Provider Demographics
NPI:1730727371
Name:GRAYSON, WHITNEY MICHELLE
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MICHELLE
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9448
Mailing Address - Country:US
Mailing Address - Phone:502-507-5439
Mailing Address - Fax:
Practice Address - Street 1:10210 DAVINHURST CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1188
Practice Address - Country:US
Practice Address - Phone:502-767-7378
Practice Address - Fax:502-470-3566
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN15-230246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician