Provider Demographics
NPI:1417282351
Name:MCCONAUGHY, GRANT BRADFORD (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:BRADFORD
Last Name:MCCONAUGHY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 MORNINGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3641
Mailing Address - Country:US
Mailing Address - Phone:561-797-8839
Mailing Address - Fax:
Practice Address - Street 1:1832 MORNINGVIEW LN
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3641
Practice Address - Country:US
Practice Address - Phone:303-660-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO190972163W00000X
MI4704383251363LF0000X
COAPN.0996865-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse