Shacoya Latrece Grady, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

L52687 Issued in AR

Practice address

3450 W 34TH Ave
Pine Bluff, AR 71603-5508

Phone

(870) 534-7392

NPI assigned

Jan 23, 2014

Last updated

Jan 23, 2014By 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 1

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": "1390435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1619390911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 S NEBRASKA ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716016197",
            "telephone_number": "870-592-3641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 W 34TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716035508",
            "telephone_number": "870-534-7392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADY",
        "first_name": "SHACOYA",
        "middle_name": "LATRECE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-23",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "L52687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tacarra Michelle Goodwin, LCSW
• Destiny Gordon
• Nikki Pepino Gordon, RPT
• O T Gordon Jr., M.D.
• Jeffrey Tad Goss, PHARMD
• Rontae Marvell Edward Graham, DDS
• Rebecca Grandy, APN
• Gray-Millenbaugh Practitioner Healthcare, LLC
• Stacy Gray, RN
• Arriel S Green, BS, MS, MHPP

• Licensed Practical Nurse in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Licensed Practical Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; 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.