Provider Demographics
NPI:1033575220
Name:GRANING, MISTY BARFOOT (PTA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:BARFOOT
Last Name:GRANING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-3654
Mailing Address - Country:US
Mailing Address - Phone:318-729-2121
Mailing Address - Fax:318-757-2310
Practice Address - Street 1:108 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-3654
Practice Address - Country:US
Practice Address - Phone:318-729-2121
Practice Address - Fax:318-757-2310
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA9264172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker