MYRA JO GRANTHAM

CONWAY, AR
NPI1528459799
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: AR  A004270)
Additional Taxonomies261QS1000X Clinic/Center, Student Health
(Licence: AR  A004270)
Enumeration Date2015-02-10
Last Update Date2019-06-10
Business Address
MYRA JO GRANTHAM NP
2302 COLLEGE AVE
CONWAY, AR 72034-6297
Phone number: 501-329-3831
Mailing Address
MYRA JO GRANTHAM NP
200 CORPORATE BLVD
LAFAYETTE, LA 70508-3870
Phone number: 800-893-9698