Provider Demographics
NPI:1427026939
Name:GRANT, GIANNA M (APN)
Entity Type:Individual
Prefix:MRS
First Name:GIANNA
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4607
Mailing Address - Country:US
Mailing Address - Phone:870-862-2285
Mailing Address - Fax:870-862-2289
Practice Address - Street 1:104 E GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4607
Practice Address - Country:US
Practice Address - Phone:870-862-2285
Practice Address - Fax:870-862-2289
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR56286163W00000X
ARA01853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158023758Medicaid
AR158023758Medicaid