Healthcare Provider Details

I. General information

NPI: 1962949768
Provider Name (Legal Business Name): SONYA M GRIGSBY ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 29TH ST STE 260
BRYAN TX
77802-2587
US

IV. Provider business mailing address

2700 E 29TH ST STE 260
BRYAN TX
77802-2587
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-0012
  • Fax: 979-774-4636
Mailing address:
  • Phone: 979-774-0012
  • Fax: 979-774-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberNUR-APRN-LIC-179400
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71012760A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP133115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: