Healthcare Provider Details

I. General information

NPI: 1992094742
Provider Name (Legal Business Name): SHAYLON CARLENE GRANT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LAKE SHORE DR
DECATUR IL
62521-3810
US

IV. Provider business mailing address

1800 E LAKE SHORE DR
DECATUR IL
62521-3810
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-6100
  • Fax: 217-422-3217
Mailing address:
  • Phone: 217-422-6100
  • Fax: 217-422-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010154
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015750
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: