Individual
MR. KEVIN LEE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 421-6283
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
R0049499
OK
367500000X
Certified Registered Nurse Anesthetist
643959
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
R49499
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100789110A
—
OK
Enumeration date
06/22/2006
Last updated
01/07/2015
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