Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | E-7744 | AR |
NPI | 1003016700 |
---|---|
Provider Name | Dr. Alissa Michelle Grant |
First Address | Mena, AR 71953-4304 |
Second Address | Mena, AR 71953-4304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 11/06/2021 |