Provider Demographics
NPI:1689131567
Name:GRADY, CHAD LEE (APRN)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:LEE
Last Name:GRADY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOSPITAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7343
Mailing Address - Country:US
Mailing Address - Phone:870-262-5545
Mailing Address - Fax:
Practice Address - Street 1:501 VIRGINIA DR STE C
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7317
Practice Address - Country:US
Practice Address - Phone:870-793-2371
Practice Address - Fax:870-793-7585
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily