Healthcare Provider Details

I. General information

NPI: 1225142722
Provider Name (Legal Business Name): SANDRA LYNN GRANT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA LYNN GRANT N.P.

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12002 TRAFALGAR AVE SUITE 201
LUBBOCK TX
79424-7668
US

IV. Provider business mailing address

12002 TRAFALGAR AVE SUITE 201
LUBBOCK TX
79424-7668
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-7764
  • Fax: 806-744-7761
Mailing address:
  • Phone: 806-744-7764
  • Fax: 806-744-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number616710
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP112706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: