Provider Demographics
NPI:1912149832
Name:GRADY, GLENDA KOUNS (ARNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:KOUNS
Last Name:GRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 EAST MTN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3375
Mailing Address - Country:US
Mailing Address - Phone:570-808-6113
Mailing Address - Fax:570-808-6349
Practice Address - Street 1:1155 EAST MTN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3375
Practice Address - Country:US
Practice Address - Phone:570-808-6113
Practice Address - Fax:570-808-6349
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9267118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9267118OtherMEDICAL LICENCSE