Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Derek Shaune Grantham

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1487485546

Mr. Derek Shaune Grantham is a Student in an Organized Health Care Education/Training Program in Pocatello, Idaho. Registered with an NPI since 2024.

In the registry since
2024
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Practice location Address checks out

921 S 8th Ave Stop 8253
Pocatello, ID 83209-0002
Phone: (208) 282-4726
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Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1487485546
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 12, 2024
Last updated in NPPESAugust 12, 2024
Certification dateAugust 11, 2024
Mailing address921 S 8th Ave Stop 8253, Pocatello, ID 83209-0002

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