MEDICARE: LINDA SIMPSON GRIMES PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024170535	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	204613	NC

General Provider Information

NPI Number	:	1598010803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA SIMPSON GRIMES PMHNP-BC

Provider Business Mailing Address
First Line	:	4901 DEER POINTE CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8714
Country	:	US
Telephone Number	:	336-674-6149
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 EDWARDS MILL RD STE 141
Second Line	:	#163
City	:	RALEIGH
State	:	NC
Zip	:	27612-5371
Country	:	US
Telephone Number	:	919-443-2360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	04/10/2023

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