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General NPI Number Information
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NPI Number | 1215683586
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Entity Type | Individual
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Provider Name | JESSICA V GRADDY APRN
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 520 N SPRING ST
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City | HARRISON
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State | AR
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Zip | 72601-3528
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Country | US
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Telephone | 870-741-8286
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2990
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City | HARRISON
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State | AR
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Zip | 72602-2990
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Country | US
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Telephone | 870-741-8286
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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 | 219058
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License Number State | AR
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