Provider Demographics
NPI:1629129051
Name:GRIMES, KELLY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:RENZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10070 WHEAT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4719
Mailing Address - Country:US
Mailing Address - Phone:469-585-1649
Mailing Address - Fax:468-287-2132
Practice Address - Street 1:10070 WHEAT RIDGE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4719
Practice Address - Country:US
Practice Address - Phone:469-585-1649
Practice Address - Fax:468-287-2132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658922163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant