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General NPI Number Information
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NPI Number | 1053878272
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Entity Type | Individual
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Provider Name | MISS KANDIS F GRANT
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Gender | Female
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Dates
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Enumeration Date | 02/24/2019
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 6505 W PARK BLVD STE 155
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City | PLANO
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State | TX
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Zip | 75093-6286
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Country | US
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Telephone | 469-304-3443
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Fax |
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Provider Business Mailing Address
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Address Line | 4944 PRESTON RD STE 100A
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City | FRISCO
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State | TX
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Zip | 75034-8987
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP140193
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License Number State | TX
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