Individual
SAMANTHA GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-5652
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-5652
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4000479
KY
363L00000X
Nurse Practitioner
APRN.CNP.0030543
OH
Other
Enumeration date
02/13/2023
Last updated
03/22/2024
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