Provider Demographics
NPI:1629437504
Name:GRAY, HILLARY L (FPMHNP)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:L
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:323 E GRAND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1447
Practice Address - Country:US
Practice Address - Phone:417-761-5600
Practice Address - Fax:417-761-5601
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0136657363LP0808X
MO2016005195363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420031052Medicaid