Healthcare Provider Details

I. General information

NPI: 1952799496
Provider Name (Legal Business Name): CATHERINE A GRIMES AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHY FRYE

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 02/24/2021
Certification Date: 12/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH CENTER DR
AHOSKIE NC
27910-8161
US

IV. Provider business mailing address

1604 ARAPAHOE TRL
EDENTON NC
27932-9111
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-3548
  • Fax: 252-332-1665
Mailing address:
  • Phone: 910-618-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5013922
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19228APRN
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: