Individual
RYAN MATISSE GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2608 E 7TH ST, STE B, CHARLOTTE, NC 28204-4375
(704) 403-2626
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5009741
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
5009741
NC
363LP2300X
Primary Care Nurse Practitioner
5009741
NC
Other
Enumeration date
12/18/2015
Last updated
07/15/2024
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