Healthcare Provider Details

I. General information

NPI: 1760030027
Provider Name (Legal Business Name): PHEBE JOY GRANDERSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHEBE JOY GRANDERSON

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S 1ST ST STE 203
ROGERS AR
72756-4504
US

IV. Provider business mailing address

214 S 1ST ST STE 203
ROGERS AR
72756-4504
US

V. Phone/Fax

Practice location:
  • Phone: 479-935-3392
  • Fax: 866-441-1301
Mailing address:
  • Phone: 479-935-3392
  • Fax: 866-441-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM002138
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM115216
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: