Provider Demographics
NPI:1114150398
Name:GRIGSBY, DAWN LYNN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LYNN
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:FNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD
Mailing Address - Street 2:STE 6
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9815
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:97 GREAT TEAYS BLVD
Practice Address - Street 2:STE 6
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9815
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-757-3252
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV41107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016001Medicaid
WV1114150398Medicaid
WVWV1593DMedicare PIN
WV3810016001Medicaid