Provider Demographics
NPI:1962949768
Name:GRIGSBY, SONYA M (ACNP)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:M
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E 29TH ST STE 260
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2587
Mailing Address - Country:US
Mailing Address - Phone:979-774-0012
Mailing Address - Fax:979-774-4636
Practice Address - Street 1:2700 E 29TH ST STE 260
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2587
Practice Address - Country:US
Practice Address - Phone:979-774-0012
Practice Address - Fax:979-774-4636
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012760A363LG0600X
TXAP133115363LA2100X
MTNUR-APRN-LIC-179400363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962949768Medicaid
TX75-2616977-042OtherTRICARE
TX369270901Medicaid
TX8229MCOtherBCBS
TXP01812736OtherRAIL ROAD MEDICARE