MEDICARE: RACHEL MANTOOTH GRIGGS FNP

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	363LF0000X	Family Nurse Practitioner	21722	SC

General Provider Information

NPI Number	:	1720576192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MANTOOTH GRIGGS FNP

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT STE 212
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 GROVE RD FL 1
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605
Country	:	US
Telephone Number	:	864-455-7899
Fax Number	:	864-455-5474

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

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	04/15/2026

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