Provider Demographics
NPI:1629669320
Name:GRIMM, KATE LAUREN (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:LAUREN
Last Name:GRIMM
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W I 240 SERVICE RD STE F100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2134
Mailing Address - Country:US
Mailing Address - Phone:405-698-9949
Mailing Address - Fax:
Practice Address - Street 1:1145 W I 240 SERVICE RD STE F100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:405-698-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine