Healthcare Provider Details

I. General information

NPI: 1518878131
Provider Name (Legal Business Name): RANDY WAYNE GRENIER NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10907 WATERSHED RD
HAVANA AR
72842-9168
US

IV. Provider business mailing address

10907 WATERSHED RD
HAVANA AR
72842-9168
US

V. Phone/Fax

Practice location:
  • Phone: 479-223-3564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number29320
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: