Provider Demographics
NPI:1598340507
Name:GRINNER, VENESHA RAYKEE
Entity Type:Individual
Prefix:
First Name:VENESHA
Middle Name:RAYKEE
Last Name:GRINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 E VETERANS MEMORIAL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5501
Mailing Address - Country:US
Mailing Address - Phone:254-598-0828
Mailing Address - Fax:
Practice Address - Street 1:5904 E VETERANS MEMORIAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5501
Practice Address - Country:US
Practice Address - Phone:254-598-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0201843747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant