Provider Demographics
NPI:1861015992
Name:GRIMM, MATTHEW J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:GRIMM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-219-3506
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:2103 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-8423
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:423-794-3184
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily