Individual
KAYLUN GRANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1952 HARRISON DRIVE, EVANSTON, WY 82930-3241
(307) 382-3064
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
(208) 542-9114
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
PA1934
NV
Other
Enumeration date
01/27/2018
Last updated
07/23/2020
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