Provider Demographics
NPI:1689317596
Name:GRIMM, LEXIE CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:LEXIE
Middle Name:CATHERINE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13406 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5312
Mailing Address - Country:US
Mailing Address - Phone:301-471-4063
Mailing Address - Fax:
Practice Address - Street 1:1050 W INDUSTRIAL BLVD STE 17
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4331
Practice Address - Country:US
Practice Address - Phone:240-964-9300
Practice Address - Fax:240-964-9310
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program