Provider Demographics
NPI:1417040098
Name:GRANT, KATHRYN L (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:GRANT
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:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:
Practice Address - Street 1:1840 MEDICAL CENTER PKWY
Practice Address - Street 2:STE 300
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2564
Practice Address - Country:US
Practice Address - Phone:615-848-0488
Practice Address - Fax:615-904-9061
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05711363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3344459Medicaid
TN3344459Medicaid
3344453Medicare ID - Type UnspecifiedMEDICARE