Healthcare Provider Details

I. General information

NPI: 1578702569
Provider Name (Legal Business Name): PATRICK ALAN GRADY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE STE 405
DENVER CO
80210-5077
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-584-8900
  • Fax: 303-584-0525
Mailing address:
  • Phone: 303-584-8900
  • Fax: 303-584-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number958096
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0995701
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: