Provider Demographics
NPI:1003158502
Name:MYERS, GRANT MARSHALL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:MARSHALL
Last Name:MYERS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MAIN STREET, BLDG A
Mailing Address - Street 2:2ND FLOOR, SUITE B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7402
Mailing Address - Country:US
Mailing Address - Phone:732-301-6904
Mailing Address - Fax:732-605-5771
Practice Address - Street 1:509 MAIN STREET, BLDG A
Practice Address - Street 2:2ND FLOOR, SUITE B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7402
Practice Address - Country:US
Practice Address - Phone:732-301-6904
Practice Address - Fax:732-605-5771
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00419200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health