Provider Demographics
NPI:1245994854
Name:GRIMM, ALEXIS ANDREA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ANDREA
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:705 GAGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9716
Mailing Address - Country:US
Mailing Address - Phone:509-907-4693
Mailing Address - Fax:509-987-1011
Practice Address - Street 1:705 GAGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9716
Practice Address - Country:US
Practice Address - Phone:509-907-4693
Practice Address - Fax:509-987-1011
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR202112082NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health