Healthcare Provider Details

I. General information

NPI: 1043274863
Provider Name (Legal Business Name): CAROLE ANN GRADY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 S BLUFF ST
ST GEORGE UT
84770-3583
US

IV. Provider business mailing address

2136 E 140 S
ST GEORGE UT
84790-1567
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-9933
  • Fax:
Mailing address:
  • Phone: 435-229-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number48399914405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: