Provider Demographics
NPI:1134764558
Name:GRADY, ANDREA PILAR (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PILAR
Last Name:GRADY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:PILAR
Other - Last Name:STAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5201 CHARLOTTE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3320
Mailing Address - Country:US
Mailing Address - Phone:615-222-1900
Mailing Address - Fax:615-222-1917
Practice Address - Street 1:5201 CHARLOTTE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3320
Practice Address - Country:US
Practice Address - Phone:615-222-1900
Practice Address - Fax:615-222-1917
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant