Provider Demographics
NPI:1174956908
Name:GRIMES, JOHN (CRNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GRIMES
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 OHARA DR
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-2597
Mailing Address - Country:US
Mailing Address - Phone:256-293-8141
Mailing Address - Fax:
Practice Address - Street 1:7938 AL HWY 69
Practice Address - Street 2:SUITE 100
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-571-8445
Practice Address - Fax:256-571-8447
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083810363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care