Provider Demographics
NPI:1003259961
Name:GRIMSLEY, BAEDA HODGES (APRN)
Entity Type:Individual
Prefix:
First Name:BAEDA
Middle Name:HODGES
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 EPHRAIM MCDOWELL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3224
Mailing Address - Country:US
Mailing Address - Phone:502-456-6200
Mailing Address - Fax:502-456-6655
Practice Address - Street 1:3532 EPHRAIM MCDOWELL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3224
Practice Address - Country:US
Practice Address - Phone:502-456-6200
Practice Address - Fax:502-456-6655
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily