Provider Demographics
NPI:1720662752
Name:GRADOS, ASHLEY (APRN-NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GRADOS
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 MCAULEY BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9309
Mailing Address - Country:US
Mailing Address - Phone:405-749-4247
Mailing Address - Fax:405-749-4249
Practice Address - Street 1:4205 MCAULEY BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9391
Practice Address - Country:US
Practice Address - Phone:405-749-4247
Practice Address - Fax:405-749-4249
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202116363LF0000X
OKR0136983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse