MEDICARE: MS. CHERYL GRISBY

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	171M00000X	Case Manager/Care Coordinator		LA

General Provider Information

NPI Number	:	1780540294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL GRISBY

Provider Business Mailing Address
First Line	:	1000 CHINABERRY DR STE 900
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 S GRAND
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202
Country	:	US
Telephone Number	:	318-324-5411
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	01/08/2026

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