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General NPI Number Information
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NPI Number | 1073920005
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Entity Type | Individual
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Provider Name | KRISTA GRANTHAM PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 133 TERRELL RD UNIT 9
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City | SAN ANTONIO
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State | TX
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Zip | 78209-6329
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Country | US
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Telephone | 830-221-6903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6141
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City | SAN ANTONIO
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State | TX
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Zip | 78209-0141
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Country | US
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Telephone | 830-221-6903
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA09328
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License Number State | TX
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