Individual
KELLY C. GRIEVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9911 N NEVADA ST, SPOKANE, WA 99218-1298
(509) 626-9420
(509) 227-7070
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
(509) 227-7070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35093040
OH
207Q00000X
Family Medicine Physician
Primary
MD60529250
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000278783
OHIO MEDICAID - UNISON
OH
01
—
1013969401214
OHIO MEDICAID - CARESOURCE
OH
05
—
2878444
—
OH
01
—
2984105
OHIO MEDICAID MOLINA
OH
05
—
3810015770
—
WV
01
—
P00766489
RR MEDICARE
—
Enumeration date
05/16/2006
Last updated
03/01/2021
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