Healthcare Provider Details

I. General information

NPI: 1720978976
Provider Name (Legal Business Name): ARISSA GRIZZLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30575 OLD BATON ROUGE HWY
HAMMOND LA
70403-8350
US

IV. Provider business mailing address

PO BOX 770
ZACHARY LA
70791-0770
US

V. Phone/Fax

Practice location:
  • Phone: 225-306-2050
  • Fax: 225-567-6962
Mailing address:
  • Phone: 225-306-2067
  • Fax: 985-229-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number241640
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: