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NPI Code Detail

MEDICARE: MRS. SARAH ELIZABETH GRIMM PA-C

MEDICARE: MRS. SARAH ELIZABETH GRIMM PA-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
1363AM0700XMedical Physician AssistantPA1029KY

General Provider Information

NPI Number : 1619163110
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARAH ELIZABETH GRIMM PA-C
Provider Business Mailing Address
First Line : 3084 LAKECREST CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1706
Country : US
Telephone Number : 859-219-6440
Fax Number : 859-219-6449
Provider Business Practice Location Address
First Line : 3084 LAKECREST CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1706
Country : US
Telephone Number : 859-219-6440
Fax Number : 859-219-6449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2007
Last Update Date : 12/03/2020

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Directions to “ MRS. SARAH ELIZABETH GRIMM PA-C” Practice Location

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