Provider Demographics
NPI:1447895289
Name:ECHETABU GRAY, VANESSA MUKASOLU (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MUKASOLU
Last Name:ECHETABU GRAY
Suffix:
Gender:F
Credentials:PMHNP-BC
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Other - First Name:
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Mailing Address - Street 1:5353 HARRY HINES BLVD # 9070
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9070
Mailing Address - Country:US
Mailing Address - Phone:214-645-8500
Mailing Address - Fax:214-648-1417
Practice Address - Street 1:1430 EMPIRE CENTRAL DR FL 1
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4032
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-648-3775
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP143630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health