Healthcare Provider Details

I. General information

NPI: 1154116101
Provider Name (Legal Business Name): DEVONA GRIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 DORCHESTER DR
ARLINGTON TX
76014-2514
US

IV. Provider business mailing address

1722 DORCHESTER DR
ARLINGTON TX
76014-2514
US

V. Phone/Fax

Practice location:
  • Phone: 414-514-2990
  • Fax:
Mailing address:
  • Phone: 414-514-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: