Provider Demographics
NPI:1578858924
Name:GRIMES, JOY R (NP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:R
Last Name:GRIMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 CONFERENCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1991
Mailing Address - Country:US
Mailing Address - Phone:615-859-6644
Mailing Address - Fax:615-859-5577
Practice Address - Street 1:913 CONFERENCE DR STE 103
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-859-6644
Practice Address - Fax:615-859-5577
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309016285363LF0000X, 363LP0808X
TN15891363LA2100X
NM65078363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309015888Medicaid