Provider Demographics
NPI:1558603563
Name:GRIMES, KRISTIN LYNCH (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LYNCH
Last Name:GRIMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6516 E MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4348
Mailing Address - Country:US
Mailing Address - Phone:225-774-7320
Mailing Address - Fax:225-774-5432
Practice Address - Street 1:6516 E MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4348
Practice Address - Country:US
Practice Address - Phone:225-774-7320
Practice Address - Fax:225-774-5432
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2329146Medicaid