Doctor Name: | SHACOYA LATRECE GRADY |
NPI Number: | 1619390911 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPN |
License Number: | L52687 |
Business Practice Address: | 3450 W 34th Ave Pine Bluff, AR - 716035508 |
Business Phone Number: | 8705347392 |
Business Fax Number: | |
Mailing Address: | 1202 S Nebraska St, PINE BLUFF |
State: | AR |
Postal Code: | 716016197 |
Phone Number: | 8705923641 |
Fax Number: | |
NPI Enumeration Date: | 01/23/2014 |
NPI Last Update Date: | 01/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 164W00000X |
License Number: | L52687 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Licensed Practical Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |