Healthcare Provider Details

I. General information

NPI: 1649193665
Provider Name (Legal Business Name): TERESA MARY FRANCES GRIGG BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 WEST RD
MOUNTAIN HOME AR
72653-4544
US

IV. Provider business mailing address

747 COUNTY ROAD 715
GASSVILLE AR
72635-8184
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-1288
  • Fax:
Mailing address:
  • Phone: 417-840-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR043111
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: