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NPI Code Detail

MEDICARE: ELISSA GRIDER APRN

MEDICARE: ELISSA GRIDER APRN
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
1363LF0000XFamily Nurse Practitioner71013093AIN
2363LF0000XFamily Nurse Practitioner3013685KY

General Provider Information

NPI Number : 1598312415
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA GRIDER APRN
Provider Business Mailing Address
First Line : 1714 CHARLESTOWN NEW ALBANY RD
Second Line :
City : JEFFERSONVILLE
State : IN
Zip : 47130-9708
Country : US
Telephone Number : 812-271-4240
Fax Number : 812-670-5720
Provider Business Practice Location Address
First Line : 1714 CHARLESTOWN NEW ALBANY RD
Second Line :
City : JEFFERSONVILLE
State : IN
Zip : 47130-9708
Country : US
Telephone Number : 812-271-4240
Fax Number : 812-670-5720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2019
Last Update Date : 04/20/2026

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