MYRA JO GRANTHAM NP NPI 1528459799

NPI Information

NPI: 1528459799
Provider Name: MYRA JO GRANTHAM, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: FAULKNER EMERGENCY GROUP, PLLC

PECOS Registration: Yes

Address:
2302 COLLEGE AVE
CONWAY, AR
ZIP 72034
Phone: (501) 329-3831
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Myra Jo Grantham, NP is a family nurse practitioner in Conway, AR with 10 years of experience. Myra Jo Grantham, NP NPI is 1528459799. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2302 COLLEGE AVE
CONWAY, AR
ZIP 72034-297
Phone: (501) 329-3831
Fax: (501) 450-2283

The NPI 1528459799 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/10/2015 and was last updated on 6/10/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QS1000X	Clinic/Center	Student Health	A004270	ARKANSAS	No
2	363LF0000X	Nurse Practitioner	Family	A004270	ARKANSAS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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