Provider Demographics
NPI:1891982872
Name:GRADY, KATRINA MARIE
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MARIE
Last Name:GRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WICKERSHAM ST
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-9117
Mailing Address - Country:US
Mailing Address - Phone:580-782-3337
Mailing Address - Fax:580-782-3339
Practice Address - Street 1:2 WICKERSHAM ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-9117
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:580-782-3339
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist