Healthcare Provider Details

I. General information

NPI: 1982276150
Provider Name (Legal Business Name): KYLA KRISTINE GRANT DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE FL 4
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

5224 75TH ST STE D
LUBBOCK TX
79424-2525
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-4900
  • Fax:
Mailing address:
  • Phone: 806-712-1096
  • Fax: 806-771-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number216132
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number216132
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number216132
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: