Provider Demographics
NPI:1609395029
Name:GRIBBLE, JAMES WYATT
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WYATT
Last Name:GRIBBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 MADISON RD FL 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1426
Mailing Address - Country:US
Mailing Address - Phone:513-861-0035
Mailing Address - Fax:513-861-0086
Practice Address - Street 1:4760 MADISON RD FL 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1426
Practice Address - Country:US
Practice Address - Phone:513-861-0035
Practice Address - Fax:513-861-0086
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG00-400-143OtherSTATE DRIVER'S LICENSE