Healthcare Provider Details

I. General information

NPI: 1962812420
Provider Name (Legal Business Name): KELLI GRIMLIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7842 W SAHARA AVE
LAS VEGAS NV
89117-1944
US

IV. Provider business mailing address

1013 STONEYPEAK AVE
NORTH LAS VEGAS NV
89081-3239
US

V. Phone/Fax

Practice location:
  • Phone: 702-636-0200
  • Fax:
Mailing address:
  • Phone: 702-478-5252
  • Fax: 888-291-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN001714
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001714
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: