MEDICARE: GRANT STAREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP132045	TX

General Provider Information

NPI Number	:	1477003358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT STAREY

Provider Business Mailing Address
First Line	:	300 ALLISON LN
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-1790
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1927 LOHMANS CROSSING RD
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5239
Country	:	US
Telephone Number	:	512-534-5039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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Directions to “ GRANT STAREY ” Practice Location

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