Doctor Name: | MARY GRANT |
NPI Number: | 1093970733 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R538515 |
Business Practice Address: | 9140 Highway 51 N Southaven, MS - 386711233 |
Business Phone Number: | 6622808222 |
Business Fax Number: | 6622805541 |
Mailing Address: | 9140 Highway 51 N, SOUTHAVEN |
State: | MS |
Postal Code: | 386711233 |
Phone Number: | 6622808222 |
Fax Number: | 6622805541 |
NPI Enumeration Date: | 07/22/2008 |
NPI Last Update Date: | 07/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R538515 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |