Healthcare Provider Details

I. General information

NPI: 1578886669
Provider Name (Legal Business Name): MICHELLE A GRIGGS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15190 COMMUNITY RD STE 100
GULFPORT MS
39503-3484
US

IV. Provider business mailing address

14055 MARTIN RD
FOLSOM LA
70437-3137
US

V. Phone/Fax

Practice location:
  • Phone: 985-264-2375
  • Fax: 985-231-6733
Mailing address:
  • Phone: 985-264-2375
  • Fax: 985-231-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number880855
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP06012
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: