Provider Demographics
NPI:1609759992
Name:GRIMM, HALEY (FNP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8766
Mailing Address - Country:US
Mailing Address - Phone:336-428-6630
Mailing Address - Fax:
Practice Address - Street 1:6301 STADIUM DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8766
Practice Address - Country:US
Practice Address - Phone:336-428-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program