Healthcare Provider Details

I. General information

NPI: 1720954738
Provider Name (Legal Business Name): JESSALYN GRANT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA STE 300
WALNUT CREEK CA
94598-3059
US

IV. Provider business mailing address

112 LA CASA VIA STE 300
WALNUT CREEK CA
94598-3059
US

V. Phone/Fax

Practice location:
  • Phone: 925-239-0012
  • Fax:
Mailing address:
  • Phone: 925-239-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number236577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: