Provider Demographics
NPI:1023568144
Name:GRISWOLD, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 BLUE RIDGE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4880
Mailing Address - Country:US
Mailing Address - Phone:816-569-0453
Mailing Address - Fax:816-569-0480
Practice Address - Street 1:6329 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4880
Practice Address - Country:US
Practice Address - Phone:816-569-0453
Practice Address - Fax:816-569-0480
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker