Healthcare Provider Details

I. General information

NPI: 1215428669
Provider Name (Legal Business Name): SHARON BETH GRIMES MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 HOBBY HORSE LN
MILFORD OH
45150-1461
US

IV. Provider business mailing address

675 HOBBY HORSE LN
MILFORD OH
45150-1461
US

V. Phone/Fax

Practice location:
  • Phone: 513-443-1700
  • Fax: 855-919-6229
Mailing address:
  • Phone: 513-443-1700
  • Fax: 855-919-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number428075
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN749771
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP024934
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0027634
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: