Provider Demographics
NPI:1619018108
Name:MCKERNAN, GRANT (NMD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:MCKERNAN
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 N 92ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4555
Mailing Address - Country:US
Mailing Address - Phone:480-860-0300
Mailing Address - Fax:480-422-4321
Practice Address - Street 1:10117 N 92ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4555
Practice Address - Country:US
Practice Address - Phone:480-860-0300
Practice Address - Fax:480-422-4321
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01-676175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath