Provider Demographics
NPI:1598010803
Name:GRIMES, LINDA SIMPSON (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SIMPSON
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 DEER POINTE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8714
Mailing Address - Country:US
Mailing Address - Phone:336-674-6149
Mailing Address - Fax:
Practice Address - Street 1:3201 EDWARDS MILL RD STE 141
Practice Address - Street 2:#163
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5371
Practice Address - Country:US
Practice Address - Phone:919-443-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170535363LP0808X
NC204613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health