Healthcare Provider Details

I. General information

NPI: 1801942255
Provider Name (Legal Business Name): VIRGINIA GRIDER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 4TH ST
MURRAY KY
42071-2002
US

IV. Provider business mailing address

71 SQUIRE RD
MURRAY KY
42071-4686
US

V. Phone/Fax

Practice location:
  • Phone: 270-753-6150
  • Fax:
Mailing address:
  • Phone: 270-759-4750
  • Fax: 270-759-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3002261
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3002261
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: