Provider Demographics
NPI:1801788021
Name:GRAYSON, DALTON RIELLY (APRN)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:RIELLY
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 HALL RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-7653
Mailing Address - Country:US
Mailing Address - Phone:423-637-6709
Mailing Address - Fax:
Practice Address - Street 1:1185 HALL RD
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-7653
Practice Address - Country:US
Practice Address - Phone:423-637-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily