Myra Jo Grantham, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A004270 Issued in AR

Practice address

2302 College Ave
Conway, AR 72034-6297

Phone

(501) 329-3831

Fax

(501) 450-2283

NPI assigned

Feb 10, 2015

Sex

Female

Sole proprietor

Yes

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

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Greenbrier Emergency Services, Inc.Group PAC ID 2668377359, 53 clinicians

Faulkner Emergency Group, PLLCGroup PAC ID 1557694049, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Conway Regional Medical Center, Inc Hospital, Conway, AR, CCN 040029

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Faulkner Emergency Group, PLLC

  • Emergency Medicine Physician
  • Conway, AR
  • NPI 1083279533
  Medicare reassignment Care Compare group NPD
• Greenbrier Emergency Services, Inc.

  • Emergency Medicine Physician
  • Gassaway, WV
  • NPI 1568401461

  AR

  Medicare reassignment Care Compare group NPD
• Conway Regional Medical Center Inc

  • General Acute Care Hospital
  • Conway, AR
  • NPI 1417024662
  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  AR

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Conway Regional Medical Center Inc

  • Rural Health Clinic/Center
  • Vilonia, AR
  • NPI 1063798858

  Hospital

  Care Compare affiliation
• Conway Regional Medical Center Inc

  • General Acute Care Hospital
  • Conway, AR
  • NPI 1497770424
  Care Compare affiliation
• Conway Regional Medical Center Inc

  • Clinical Medical Laboratory
  • Conway, AR
  • NPI 1609123017

  Hospital

  Care Compare affiliation
• Conway Regional Medical Center, Inc

  • Family Medicine Physician
  • Russellville, AR
  • NPI 1245729359

  Hospital

  Care Compare affiliation
• Conway Regional Medical Center, Inc

  • Psychiatry Physician
  • Conway, AR
  • NPI 1730402249

  Hospital

  Care Compare affiliation
• Conway Regional Medical Center, Inc.

  • Rural Health Clinic/Center
  • Mayflower, AR
  • NPI 1851389605

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1528459799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346297",
            "telephone_number": "501-329-3831",
            "fax_number": "501-450-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANTHAM",
        "first_name": "MYRA",
        "middle_name": "JO",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-10",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "AR",
            "license": "A004270",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A004270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristy L Grady
• Morgan Graham, LPC
• Tyler Lee Graham, PT
• Malcolm Grant
• Amanda Grantham
• Mary Grasse
• Noah Douglas Graves, PHARMD
• Joshua Grant Gray
• Kara Gray
• Kristi Lyn Marie Gray

• Family Nurse Practitioner in Conway, AR
• Providers in Conway, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.