Individual
KATY GRISMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1001 HADLEY RD STE LL050, MOORESVILLE, IN 46158-1883
(317) 834-3502
(317) 834-3519
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006027A
IN
363LP0200X
Pediatric Nurse Practitioner
28197474A
IN
Other
Enumeration date
01/08/2016
Last updated
07/31/2023
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