Healthcare Provider Details

I. General information

NPI: 1437089232
Provider Name (Legal Business Name): GRANT EDWARDS DNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

6201 JOHNSON DR APT 518
MISSION KS
66202-3484
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-1000
  • Fax:
Mailing address:
  • Phone: 501-615-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14-156468-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: