Provider Demographics
NPI:1962153718
Name:GRIMES, CASSI RENEE (APRN)
Entity type:Individual
Prefix:
First Name:CASSI
Middle Name:RENEE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASSI
Other - Middle Name:RENEE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:267 W COLLEEN CT
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1900
Mailing Address - Country:US
Mailing Address - Phone:913-952-2456
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1126
Practice Address - Country:US
Practice Address - Phone:913-755-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80825-061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner