Provider Demographics
NPI:1164737961
Name:GRIMES, DARLA A (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:A
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RN, FNP-C
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Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1807 SLAUGHTER LANE # 490
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6237
Practice Address - Country:US
Practice Address - Phone:512-282-8967
Practice Address - Fax:512-406-7351
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX664729363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282288401Medicaid
TXTXB126564Medicare PIN
TX282288401Medicaid