Provider Demographics
NPI:1215428669
Name:GRIMES, SHARON BETH (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:BETH
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MATHEWS RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1463
Mailing Address - Country:US
Mailing Address - Phone:234-313-5870
Mailing Address - Fax:
Practice Address - Street 1:675 HOBBY HORSE LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1461
Practice Address - Country:US
Practice Address - Phone:513-443-1700
Practice Address - Fax:855-919-6229
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH428075163W00000X
PARN749771163W00000X
PASP024934363LP0808X
OHAPRN.CNP.0027634363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
163W00000XOtherREGISTERED NURSE