Healthcare Provider Details

I. General information

NPI: 1376477414
Provider Name (Legal Business Name): KAYCE MICHELE GRANGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 31ST AVE
GULFPORT MS
39501-1847
US

IV. Provider business mailing address

15366 WOODMANSE WAY
DIBERVILLE MS
39540-6520
US

V. Phone/Fax

Practice location:
  • Phone: 228-731-3500
  • Fax:
Mailing address:
  • Phone: 228-731-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: