Individual
CRYSTAL L GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10202 W 13TH ST N, WICHITA, KS 67212-4377
(316) 729-9100
(316) 729-9185
Mailing address
10202 W 13TH ST N, WICHITA, KS 67212-4377
(316) 729-9100
(316) 729-9185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-00627
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719196
MEDICARE
—
05
—
200003740 A
—
KS
Enumeration date
04/27/2006
Last updated
08/09/2022
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