Most Relevant Information
Provider Data
| NPI Number: | 1003522293 |
| Provider Name: | BLAKE ALAN GRANT PMHNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 1109094 |
Most Important Dates
| Enumeration Date: | 01/30/2023 |
| Last Updated: | 08/30/2023 |
Provider Practice Location
4005 BANISTER LN STE 200C
AUSTIN
TX
787048077
Practice Location Phone/Fax
| Phone: | 5123287222 |
| Fax: |
Provider Mailing Location
4005 BANISTER LN STE 200C
AUSTIN
TX
787048077
Provider Mailing Phone/Fax
| Phone: | 8068931778 |
| Fax: |