Active NPI
Kevin E Grant, M.D.
- Pediatrics Physician
- Boise, ID
National Provider Identifier
1730107368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MV-0025
- Practice address
- 13164 N. Town Ridge Rd
Boise, ID 83714 - Phone
- (916) 989-6400
- Fax
- (916) 635-8047
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MV-0025 | ID | Primary |
Addresses
Primary practice location
13164 N. Town Ridge Rd
Boise, ID 83714
Mailing address
1004 River Rock #131
#131
Folsom, CA 95630-2095
Phone (916) 989-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MV-0025 | ID | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693008000000",
"number": "1730107368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 RIVER ROCK #131",
"address_2": "#131",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956302095",
"telephone_number": "916-989-6400",
"fax_number": "916-635-8047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13164 N. TOWN RIDGE RD",
"city": "BOISE",
"state": "ID",
"postal_code": "83714",
"telephone_number": "916-989-6400",
"fax_number": "916-635-8047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "KEVIN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2023-08-26",
"certification_date": "2023-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ID",
"license": "MV-0025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.