Siovhan Reene Grant
Nurse Practitioner, Family in Waco, TX. Individual provider (NPI-1).
NPI number1104499375
StatusActive
Last updated in NPPESSep 16, 2021
Details
- NPI
- 1104499375
- Entity type
- Individual (NPI-1)
- Name
- Siovhan Reene Grant
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 23, 2021
- Certification date
- Sep 16, 2021
- Last updated
- Sep 16, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 1048328 | TX | Yes |
Practice location
7300 Bosque BlvdWaco, TX 76710-4023
Phone 254-202-2600
Mailing address
Po Box 844658Dallas, TX 75284-4658
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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