MEDICARE: DARLA A GRIMES RN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	664729	TX
2	363L00000X	Nurse Practitioner	664729	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164737961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLA A GRIMES RN, FNP-C

Provider Business Mailing Address
First Line	:	4515 SETON CENTER PKWY
Second Line	:	SUITE 215
City	:	AUSTIN
State	:	TX
Zip	:	78759-5290
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 SLAUGHTER LANE # 490
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6237
Country	:	US
Telephone Number	:	512-282-8967
Fax Number	:	512-406-7351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	02/20/2017

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