Grand Primary Care Clinics

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

GRAND PRIMARY CARE CLINICS

Practice address

5401 N Portland Ave
Suite 270
Oklahoma City, OK 73112-2121

Phone

(405) 605-0108

Fax

(405) 463-0120

NPI assigned

Sep 17, 2016

Last updated

Mar 28, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

KIMBACO, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Jeff J Hunter, DPH

Title

Owner

Phone

(405) 418-2929

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1474070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490659200000",
    "number": "1336697432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N PORTLAND AVE",
            "address_2": "SUITE 270",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731122121",
            "telephone_number": "405-605-0108",
            "fax_number": "405-463-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N PORTLAND AVE",
            "address_2": "SUITE 270",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731122121",
            "telephone_number": "405-605-0108",
            "fax_number": "405-463-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRIMARY CARE CLINICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIMBACO, LLC",
        "enumeration_date": "2016-09-17",
        "last_updated": "2017-03-28",
        "status": "A",
        "authorized_official_last_name": "HUNTER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-418-2929",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Brade Granato, PHARMD.
• Stephani Lynn Granato, PHD
• Grand Lake Mental Health Center, Inc.
• Grand Lake Mental Health Center, Inc.
• Grand Prairie Pediatric and Allergy Clinic Inc
• Grand Slam Rehabilitation L.L.C.
• Grand Village in Home Care
• Michael Henry Grandison, DO
• Gloria Granillo
• Grant Johnson

• Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; 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.