Provider Demographics
NPI:1346391273
Name:GRIGSBY, SUSAN K (RN, MSN, NP-C, CHPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:RN, MSN, NP-C, CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 STATE HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-4830
Mailing Address - Country:US
Mailing Address - Phone:830-796-7713
Mailing Address - Fax:830-796-7744
Practice Address - Street 1:1050 HWY 16 S
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-4830
Practice Address - Country:US
Practice Address - Phone:830-796-7713
Practice Address - Fax:830-796-7744
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2006010375363LG0600X
TX689000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6890000OtherRN BOARD OF EXAM
TX2006010375OtherGERONTOLOGICAL NURSE PRAC