Healthcare Provider Details

I. General information

NPI: 1043696529
Provider Name (Legal Business Name): AMY GRIMES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

62 BUD GRIMES RD
WARD AR
72176-8762
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax:
Mailing address:
  • Phone: 501-743-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR072185
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: