Provider Demographics
NPI:1184654683
Name:GRADY, KATHRYN C (CNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:C
Last Name:GRADY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 E 116TH ST
Mailing Address - Street 2:METROHEALTH BUCKEYE HEALTH CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2111
Mailing Address - Country:US
Mailing Address - Phone:216-957-4000
Mailing Address - Fax:
Practice Address - Street 1:2816 E 116TH ST
Practice Address - Street 2:METROHEALTH BUCKEYE HEALTH CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2111
Practice Address - Country:US
Practice Address - Phone:216-957-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP00321363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2067856Medicaid
OH2067856Medicaid
OHGRNP75551Medicare ID - Type Unspecified