Healthcare Provider Details

I. General information

NPI: 1639913494
Provider Name (Legal Business Name): AMBER GRISHAM CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W GROVE ST
KAUFMAN TX
75142-1882
US

IV. Provider business mailing address

1011 W GROVE ST
KAUFMAN TX
75142-1882
US

V. Phone/Fax

Practice location:
  • Phone: 214-221-0855
  • Fax:
Mailing address:
  • Phone: 214-221-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1164915
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: