Provider Demographics
NPI:1538829601
Name:GRADY, KERRI MISCHELLE (NP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:MISCHELLE
Last Name:GRADY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:MISCHELLE
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:68 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03455-2530
Mailing Address - Country:US
Mailing Address - Phone:603-812-5141
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH077837-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily