Provider Demographics
NPI:1215414172
Name:GRADY, SARAH E (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:GRADY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HWY 75
Mailing Address - Street 2:SUITE 300, ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4587
Mailing Address - Country:US
Mailing Address - Phone:903-416-6200
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 110
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4596
Practice Address - Country:US
Practice Address - Phone:903-416-6200
Practice Address - Fax:903-416-6201
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner