Casey Grad Granbois

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

202100056 Issued in OR

Practice address

812 SW Washington St
Portland, OR 97205-3222

Phone

(503) 622-8964

NPI assigned

Mar 30, 2019

Last updated

Apr 19, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1154882132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 SE 69TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061948",
            "telephone_number": "503-421-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 SW WASHINGTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053222",
            "telephone_number": "503-622-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAD GRANBOIS",
        "first_name": "CASEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-30",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202100056",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terresa Diane Grace, CPM, LM
• Thomas Grace, DC
• Graceful Speech and Swallow Solutions, LLC
• Gracelen Terrace Managing Company (Harrison Manor Long-Term Care Facility)
• Saige A. Gracie, CADCI
• Kimberly C Grady, PA-C
• Mary Grady, MSW
• Michael Cory Grady, N.D.
• Scott P Grady, MD
• Jordan Michelle Graeme, DC

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.