Provider Demographics
NPI:1750587457
Name:GRIDLEY, ROBERTA R (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:R
Last Name:GRIDLEY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 E COUNTY ROAD 1150 N
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8744
Mailing Address - Country:US
Mailing Address - Phone:317-374-4431
Mailing Address - Fax:
Practice Address - Street 1:7010 ROWAN HILL DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3380
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2024085294363LA2100X
OHAPRN.CNP.0037844363LA2100X
IN28188662A163W00000X
OHRN.491585163W00000X
IN27056431A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse