Provider Demographics
NPI:1134888597
Name:STORY, GRANT ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:ROBERT
Last Name:STORY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1160 E SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4853
Mailing Address - Country:US
Mailing Address - Phone:812-885-8763
Mailing Address - Fax:812-885-8499
Practice Address - Street 1:406 N 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1358
Practice Address - Country:US
Practice Address - Phone:812-882-5220
Practice Address - Fax:128-868-9388
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2024-02-26
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant