Individual
SHACOYA LATRECE GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3450 W 34TH AVE, PINE BLUFF, AR 71603-5508
(870) 534-7392
Mailing address
1202 S NEBRASKA ST, PINE BLUFF, AR 71601-6197
(870) 592-3641
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L52687
AR
Other
Enumeration date
01/23/2014
Last updated
01/23/2014
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