MEDICARE: HEATHER GRIGSBY APRN

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	A004136	AR

General Provider Information

NPI Number	:	1881002756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GRIGSBY APRN

Provider Business Mailing Address
First Line	:	1002 SCHNEIDER DR
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-4816
Country	:	US
Telephone Number	:	501-337-9044
Fax Number	:	501-332-5265

Provider Business Practice Location Address
First Line	:	1002 SCHNEIDER DR
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-4816
Country	:	US
Telephone Number	:	501-337-9044
Fax Number	:	501-332-5265

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/23/2014

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Directions to “ HEATHER GRIGSBY APRN” Practice Location

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