Provider Demographics
NPI:1760155592
Name:GRIMMETT, KELSEY RENEE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE
Last Name:GRIMMETT
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 1:6400 BUFFALO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AMHERSTDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25607-8088
Mailing Address - Country:US
Mailing Address - Phone:304-687-6955
Mailing Address - Fax:
Practice Address - Street 1:6400 BUFFALO CREEK RD
Practice Address - Street 2:
Practice Address - City:AMHERSTDALE
Practice Address - State:WV
Practice Address - Zip Code:25607-8088
Practice Address - Country:US
Practice Address - Phone:304-687-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant