Active NPI
Kevin Lee Grant, C.R.N.A.
- Certified Registered Nurse Anesthetist
- Ada, OK
National Provider Identifier
1861438012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- R49499
- Practice address
- 1921 Stonecipher Dr
Ada, OK 74820-3439 - Phone
- (580) 436-3980
- Fax
- (580) 421-6283
- NPI assigned
- Jun 22, 2006
- Last updated
- Jan 7, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R49499 | OK | Primary |
| Certified Registered Nurse Anesthetist | 367500000X | 643959 | TX | |
| Anesthesiology Physician | 207L00000X | R0049499 | OK |
Addresses
Primary practice location
1921 Stonecipher Dr
Ada, OK 74820-3439
Mailing address
1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100789110A | Medicaid | OK |
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)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0049499 | OK | MD | Anesthesiology Physician |
| R49499 | OK | MD | Certified Registered Nurse Anesthetist |
| 643959 | TX | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ardmore Anesthesia, Inc. | Anesthesiology | Past | Accepting new patients |
| Regional Anesthesia SVS LC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Southern Oklahoma Surgical Center Inc | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Anesthesiology Physician
- Ardmore, OK
- NPI 1558338400
-
- Certified Registered Nurse Anesthetist
- Poteau, OK
- NPI 1609959808
Nurse Anesthetist, Certified Registered
-
- Ambulatory Surgical Clinic/Center
- Ardmore, OK
- NPI 1699767210
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420588800000",
"number": "1861438012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1921 STONECIPHER DR",
"city": "ADA",
"state": "OK",
"postal_code": "748203439",
"telephone_number": "580-436-3980",
"fax_number": "580-421-6283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1921 STONECIPHER DR",
"city": "ADA",
"state": "OK",
"postal_code": "748203439",
"telephone_number": "580-436-3980",
"fax_number": "580-421-6283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "KEVIN",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "C.R.N.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2015-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "OK",
"license": "R49499",
"primary": true
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "643959",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OK",
"license": "R0049499",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100789110A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Ada, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.