Provider Demographics
NPI:1427736362
Name:GRIMLEY, BRIAN PATRICK (APRN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:GRIMLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SURFACE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8640
Mailing Address - Country:US
Mailing Address - Phone:708-705-1683
Mailing Address - Fax:
Practice Address - Street 1:1167 WILSON DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8221
Practice Address - Country:US
Practice Address - Phone:844-457-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210534A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health