Provider Demographics
NPI:1093262057
Name:GRANT, GEORGEANNA (APRN)
Entity Type:Individual
Prefix:
First Name:GEORGEANNA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27766
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2029
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:210 W MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1812
Practice Address - Country:US
Practice Address - Phone:859-236-3726
Practice Address - Fax:859-236-3019
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004763364SA2100X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100564260Medicaid