Individual
TRACIE GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-0609
Mailing address
961 OLMSTEAD ST, CHESAPEAKE, VA 23323-1463
(757) 319-7202
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
0001192036
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020146276
VA
Other
Enumeration date
07/02/2021
Last updated
10/21/2024
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