Provider Demographics
NPI:1316647654
Name:GRIMES, CALEB ALEXANDER
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:ALEXANDER
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 SHELBY DRY FRK
Mailing Address - Street 2:
Mailing Address - City:SHELBIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41562-8414
Mailing Address - Country:US
Mailing Address - Phone:859-248-1676
Mailing Address - Fax:
Practice Address - Street 1:2446 SHELBY DRY FRK
Practice Address - Street 2:
Practice Address - City:SHELBIANA
Practice Address - State:KY
Practice Address - Zip Code:41562-8414
Practice Address - Country:US
Practice Address - Phone:859-248-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist