Provider Demographics
NPI:1477322303
Name:GRIESELDING, JACEY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:MARIE
Last Name:GRIESELDING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-1549
Mailing Address - Country:US
Mailing Address - Phone:616-450-3816
Mailing Address - Fax:
Practice Address - Street 1:30 W RAMPART ST STE 250
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8897
Practice Address - Country:US
Practice Address - Phone:317-398-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical