Provider Demographics
NPI:1518907799
Name:GRIMM, ANDREA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:WINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1431 CENTERPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1984
Mailing Address - Country:US
Mailing Address - Phone:865-985-7221
Mailing Address - Fax:865-560-7114
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3742
Practice Address - Country:US
Practice Address - Phone:859-313-1176
Practice Address - Fax:859-313-3586
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00772363AM0700X
KYPA2074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical