Provider Demographics
NPI:1902558299
Name:GRIGSBY, CHASSIDY RENEE
Entity type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:RENEE
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHASSIDY
Other - Middle Name:
Other - Last Name:OATMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 460
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5908
Mailing Address - Country:US
Mailing Address - Phone:419-226-4300
Mailing Address - Fax:419-996-4305
Practice Address - Street 1:770 W HIGH ST STE 460
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5908
Practice Address - Country:US
Practice Address - Phone:419-226-4300
Practice Address - Fax:419-996-4305
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH50.008762RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program