Provider Demographics
NPI:1336766369
Name:GRIMES, DUSTIN ROSS (NP)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:ROSS
Last Name:GRIMES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-635-6777
Mailing Address - Fax:252-634-3183
Practice Address - Street 1:1001 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5253
Practice Address - Country:US
Practice Address - Phone:252-635-6777
Practice Address - Fax:252-634-3183
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013220363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care