Provider Demographics
NPI:1083094908
Name:GRADY, GINA MARIE (MSN APRN-CNS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:GRADY
Suffix:
Gender:F
Credentials:MSN APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 W ROCK CREEK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2466
Mailing Address - Country:US
Mailing Address - Phone:405-759-8407
Mailing Address - Fax:405-724-6482
Practice Address - Street 1:3650 W ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-701-4909
Practice Address - Fax:405-310-6161
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0070010364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist