GRAYSON TYLER GLENN MD
NPI 1952099723
Student in an Organized Health Care Education/Training Program in Little Rock, AR

Q: What is Grayson Glenn's NPI number?

The NPI number for Grayson Glenn is 1952099723. It was assigned to this individual provider in the NPPES registry on April 28, 2023.

Q: What is Grayson Glenn's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Grayson Glenn was last updated on April 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 28, 2023PECOS Enrolled

4301 W MARKHAM ST # 837, LITTLE ROCK, AR 72205(501) 626-1876 Get Directions Write a Review

NPPES record last updated: April 28, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Grayson Tyler Glenn Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAYSON TYLER GLENN MD (NPI 1952099723) is an individual student in an organized health care education/training program in Little Rock, Arkansas and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1952099723

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameGRAYSON TYLER GLENNCredential: MD

Location Address4301 W MARKHAM ST # 837Little Rock, AR 72205-7101

Mailing Address3400 S Bowman Rd Apt 1523Little Rock, AR 72211-4672 · (501) 628-8737

Phone(501) 626-1876

Sole ProprietorYes

Enumeration DateApril 28, 2023

NPPES CertifiedApril 28, 2023

✔ NPI 1952099723 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4301 W MARKHAM ST # 837, Little Rock, AR 72205

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Grayson Tyler Glenn Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANTONIA BANNISTER

Student in an Organized Health Care Education/Training Program