Provider Demographics
NPI:1013377415
Name:GRINDER, CHARLES (APRN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:GRINDER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MOUNTAIN PLACE DR STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6801
Mailing Address - Country:US
Mailing Address - Phone:870-269-3447
Mailing Address - Fax:870-269-3448
Practice Address - Street 1:102 MOUNTAIN PLACE DR STE C
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560
Practice Address - Country:US
Practice Address - Phone:870-269-3447
Practice Address - Fax:870-269-3448
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily