Provider Demographics
NPI:1679116024
Name:GRANT, MICHELLE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MARK CIR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5617
Mailing Address - Country:US
Mailing Address - Phone:870-723-5376
Mailing Address - Fax:
Practice Address - Street 1:130 MARK CIR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5617
Practice Address - Country:US
Practice Address - Phone:870-723-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122325363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care