Healthcare Provider Details

I. General information

NPI: 1063250793
Provider Name (Legal Business Name): KIMESHA C GRANT DNP, MPH, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMESHA LINTON

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N WOLFE ST
BALTIMORE MD
21205-2110
US

IV. Provider business mailing address

1246 KENLEY SQ
RICHMOND VA
23226-2968
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-4766
  • Fax:
Mailing address:
  • Phone: 954-934-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: