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General NPI Number Information
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NPI Number | 1194546531
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Entity Type | Individual
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Provider Name | SAMMI JO GRIMES APRN
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 3640 SE FRANK PHILLIPS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006
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Country | US
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Telephone | 918-332-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 15161 N 3960 RD
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City | DEWEY
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State | OK
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Zip | 74029-3409
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Country | US
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Telephone | 918-440-3326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 221009
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F09240267
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License Number State | OK
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