Provider Demographics
NPI:1669675765
Name:GRANTOM, PATRICIA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:GRANTOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6243 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4045
Mailing Address - Country:US
Mailing Address - Phone:281-991-6403
Mailing Address - Fax:281-991-6405
Practice Address - Street 1:6243 FAIRMONT PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4045
Practice Address - Country:US
Practice Address - Phone:281-991-6403
Practice Address - Fax:281-991-6405
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX238530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3197238Medicaid