Provider Demographics
NPI:1205308228
Name:GRIMES, KAYLEIGH NOELLE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:NOELLE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:N
Other - Last Name:PIPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 N 100 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1504
Mailing Address - Country:US
Mailing Address - Phone:760-608-2868
Mailing Address - Fax:
Practice Address - Street 1:15 S 1000 E STE 225
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5593
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant