MEDICARE: MRS. VICKI LYNN GRIMES ARNP

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	363LC1500X	Community Health Nurse Practitioner	AP60669354	WA
2	363L00000X	Nurse Practitioner	AP60669354	WA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60669354	WA

General Provider Information

NPI Number	:	1548710551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKI LYNN GRIMES ARNP

Provider Business Mailing Address
First Line	:	7406 27TH ST W STE 30
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4637
Country	:	US
Telephone Number	:	253-244-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 27TH ST W STE 30
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4637
Country	:	US
Telephone Number	:	253-244-3477
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	09/26/2023

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