Provider Demographics
NPI:1477313658
Name:GRANT, MARY KATHERINE (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 GUNBARREL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3897
Mailing Address - Country:US
Mailing Address - Phone:423-553-5999
Mailing Address - Fax:
Practice Address - Street 1:1511 GUNBARREL RD STE 111
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3897
Practice Address - Country:US
Practice Address - Phone:423-553-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35851176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife