Healthcare Provider Details

I. General information

NPI: 1902795552
Provider Name (Legal Business Name): ALESHIA GRIZZLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21052 RIVERSIDE DR STE 4
GRUNDY VA
24614-9208
US

IV. Provider business mailing address

1829 ELKINS BRANCH RD
GRUNDY VA
24614-7000
US

V. Phone/Fax

Practice location:
  • Phone: 276-282-8810
  • Fax:
Mailing address:
  • Phone: 276-202-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193761
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024193761
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024193761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: