Healthcare Provider Details

I. General information

NPI: 1083094908
Provider Name (Legal Business Name): GINA MARIE GRADY MSN APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 W ROCK CREEK RD
NORMAN OK
73072-2202
US

IV. Provider business mailing address

3411 W ROCK CREEK RD STE 120
NORMAN OK
73072-2466
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-4909
  • Fax: 405-310-6161
Mailing address:
  • Phone: 405-759-8407
  • Fax: 405-724-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR0070010
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: