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General NPI Number Information
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NPI Number | 1902253339
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Entity Type | Individual
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Provider Name | JILLIAN GRIMM
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Gender | Female
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 598 N UNION AVE STE 200
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-4179
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Country | US
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Telephone | 830-730-5006
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Fax | 833-464-3377
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Provider Business Mailing Address
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Address Line | PO BOX 911230
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City | DALLAS
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State | TX
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Zip | 75391-1230
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Country | US
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Telephone | 972-997-8000
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Fax | 972-234-0813
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10056085
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | T8550
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | T8550
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License Number State | TX
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