Healthcare Provider Details

I. General information

NPI: 1578559498
Provider Name (Legal Business Name): JAN LYNN GRIMES R.N.,N.P.,L.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N HAMPTON RD SUITE 250
DESOTO TX
75115-8300
US

IV. Provider business mailing address

1510 N HAMPTON RD SUITE 250
DESOTO TX
75115-8300
US

V. Phone/Fax

Practice location:
  • Phone: 214-502-6942
  • Fax: 214-351-2884
Mailing address:
  • Phone: 214-502-6942
  • Fax: 214-351-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number236780
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12493
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: