Individual
TOMAS KARLTON GRANT SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-3522
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
232793
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
1066667
TX
363LA2100X
Acute Care Nurse Practitioner
250379
WI
363LA2100X
Acute Care Nurse Practitioner
APRN11021135
FL
363LG0600X
Gerontology Nurse Practitioner
APRN11021135
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023660974
—
WI
05
—
116405000
—
FL
Enumeration date
07/11/2019
Last updated
02/15/2023
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