Individual
KIMBERLY LEACH GRANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1171 PELICAN CREEK DR, SHREVEPORT, LA 71106-8539
(318) 780-0716
Mailing address
1171 PELICAN CREEK DR, SHREVEPORT, LA 71106-8539
(318) 780-0716
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN097823-AP05716
LA
Other
Enumeration date
02/18/2009
Last updated
06/05/2012
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