Stephen Grantham, RN
Individual provider Active NPI Registered Nurse · Vilonia, AR
NPI 1043679129 · NPPES record last updated Feb 17, 2016
Key facts
- NPI
- 1043679129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R095593 (AR)
- Practice address
- 39 Ridgewood Loop
Vilonia, AR 72173-8058 - Phone
- (501) 912-6884
- NPI assigned
- Feb 17, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R095593 | AR | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R095593 | AR | Yes |
Addresses
Primary practice location
39 Ridgewood Loop
Vilonia, AR 72173-8058
Mailing address
39 Ridgewood Loop
Vilonia, AR 72173-8058
Phone (501) 912-6884
Other providers in Vilonia, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.