Doctor Name: | ASHLEY TERRITO GRADY |
NPI Number: | 1265873939 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | AP07361 |
Business Practice Address: | 310 Durel Dr New Roads, LA - 707602973 |
Business Phone Number: | 2257132400 |
Business Fax Number: | 2257132405 |
Mailing Address: | 310 Durel Dr, NEW ROADS |
State: | LA |
Postal Code: | 707602973 |
Phone Number: | 2257132400 |
Fax Number: | 2257132405 |
NPI Enumeration Date: | 07/10/2013 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP07361 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |