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General NPI Number Information
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NPI Number | 1689348443
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Entity Type | Individual
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Provider Name | CARLEE MAE GRIMES
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Gender | Female
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 512 N FRANKLIN ST FL 2
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City | JENKS
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State | OK
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Zip | 74037-2490
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Country | US
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Telephone | 918-582-6800
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Fax | 918-582-6060
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Provider Business Mailing Address
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Address Line | 2431 E 61ST ST STE 500
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City | TULSA
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State | OK
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Zip | 74136-1208
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Country | US
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Telephone | 918-582-6800
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Fax | 918-582-6060
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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