Healthcare Provider Details

I. General information

NPI: 1285776260
Provider Name (Legal Business Name): JERI DENISE GRIGGS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 US HIGHWAY 64
MANTEO NC
27954-9241
US

IV. Provider business mailing address

715 N MAIN HWY 64
MANTEO NC
27954-9241
US

V. Phone/Fax

Practice location:
  • Phone: 252-473-2500
  • Fax: 252-473-1222
Mailing address:
  • Phone: 252-473-2500
  • Fax: 252-473-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9401185
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: