Healthcare Provider Details

I. General information

NPI: 1285019612
Provider Name (Legal Business Name): HEATHER RHEA GRIDLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER HARTIN MD

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13103 E MANSFIELD AVE
SPOKANE VALLEY WA
99216-1642
US

IV. Provider business mailing address

PO BOX 3405
SPOKANE WA
99220-3405
US

V. Phone/Fax

Practice location:
  • Phone: 509-892-2700
  • Fax: 509-892-2740
Mailing address:
  • Phone: 509-892-2700
  • Fax: 509-342-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20996
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number63831
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD218306
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD61512839
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMEDPHYSCOMLIC131870
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMC-2544
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number216589
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: