Individual
KRISTEN ELAINE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
145 WEST AVE, TALLMADGE, OH 44278-2250
(330) 633-8341
(330) 633-8462
Mailing address
145 WEST AVE, TALLMADGE, OH 44278-2250
(330) 633-8341
(330) 633-8462
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1805
MA
363A00000X
Physician Assistant
Primary
50.2875
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9768939
—
MA
Enumeration date
07/05/2006
Last updated
12/28/2020
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