Provider Demographics
NPI:1184353690
Name:GRIDER, KIMBERLY (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:GRIDER
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2800
Mailing Address - Country:US
Mailing Address - Phone:317-266-2901
Mailing Address - Fax:
Practice Address - Street 1:8470 ALLISON POINTE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4368
Practice Address - Country:US
Practice Address - Phone:317-554-4220
Practice Address - Fax:317-554-4220
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012798A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health