CRYSTAL L GRIMES (NPI# 1780641233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780641233 |
| Entity Type | Individual |
| Full Name | CRYSTAL L GRIMES |
| Credential | PA-C |
| Practice Address |
7348 W 21st St N Ste 121 Wichita KS 67205-1765 |
| Mailing Address |
Po Box 8035 Wichita KS 67208-0035 |
| Practice Telephone | 3167220103 |
| Practice Fax Number | 3167222333 |
| Mailing Telephone | (316) 689-9135 |
| Mailing Fax Number | 3166899667 |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2017-08-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 15-00627 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE | 003719196 | 01 | |
| KS | 200003740 A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699135657 | Crystal Grimes | Nurse Practitioner | 280 Beach St, Revere, MA 02151-3143 | 2016-03-03 |
| 1790865574 | Crystal Grimes | Pharmacist | 1750 N Main St, Logan, UT 84341-1922 | 2006-10-16 |
| Street Address |
7348 W 21ST ST N STE 121 |
| City | WICHITA |
| State | KS |
| Zip Code | 67205-1765 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851891352 | Julie Cecile Short | Nurse Practitioner | 7348 W 21st St N Ste 121, Wichita, KS 67205-1765 | 2018-02-20 |
| 1427183227 | Vonda M Wigal | Nurse Practitioner | 7348 W 21st St N Ste 121, Wichita, KS 67205-1765 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295211910 | Emily M Chastain | Dentist | 3213 N. Ridge Rd, Wichita, KS 67205 | 2018-07-16 |
| 1811415466 | Awaken Psychology LLC | Clinic/Center | 2552 N Maize Ct Suite 600, Wichita, KS 67205 | 2017-09-05 |
| 1962940288 | Moc Wichita LLC | Assisted Living Facility | 7057 W Village Circle, Wichita, KS 67205 | 2017-02-07 |
| 1003362732 | Moc Wichita, LLC | Assisted Living Facility | 7057 West Village Circle, Wichita, KS 67205 | 2016-09-01 |
| 1649637653 | Abigail Friend | Audiologist-Hearing Aid Fitter | 2558 Lake Way Circle, Wichita, KS 67205 | 2016-01-21 |
| 1134505399 | Myles Davidson | Dentist | 3510 N Ridge Rd Ste 500, Wichita, KS 67205 | 2015-08-10 |
| 1093121097 | The Eye Gallery, LLC | Optometrist | 3084 N. Maize Rd, Wichita, KS 67205 | 2014-07-10 |
| 1922428721 | Sam's West, Inc. | Technician/Technologist | 3084 N. Maize Road, Witchita, KS 67205 | 2014-04-18 |
| 1447693627 | Caryn Rana Landreth | Social Worker | 3114 N Brush Creek St, Wichita, KS 67205 | 2013-04-08 |
| 1902182686 | Return To Motion Medical | Durable Medical Equipment & Medical Supplies | 3221 N Ridge Port Circle, Wichita, KS 67205 | 2011-10-26 |
| Find all providers in zip 67205 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871116582 | Alia Porter | Physician Assistant | 115 N Terrace Dr, Wichita, KS 67208-3941 | 2020-05-28 |
| 1881217594 | Taylor Nicole Wondra | Physician Assistant | 1845 N Woodrow Ct, Wichita, KS 67203-2959 | 2020-05-28 |
| 1497378087 | Haley Nicole Northcutt | Physician Assistant | 10107 W Jamesburg St, Wichita, KS 67212-6743 | 2020-05-18 |
| 1649892357 | Mong Trinh Thi Hoang | Physician Assistant | 1933 N Wellington Pl, Wichita, KS 67203-2558 | 2020-05-15 |
| 1609434000 | Branden Tang | Physician Assistant | 10112 E Clark St, Wichita, KS 67207-7747 | 2019-05-31 |
| 1184093379 | Evan C Ohlman | Physician Assistant | 3009 N Cypress, Wichita, KS 67226-4003 | 2015-09-18 |
| 1629388079 | Sara A Hildreth | Physician Assistant | 9415 E Harry St Ste 202, Wichita, KS 67207-5076 | 2010-10-19 |
| 1477700235 | Heather S Bloomer | Physician Assistant | 2465 N Woodridge Ct, Wichita, KS 67226-8208 | 2008-08-25 |
| 1205030145 | William Paul Wondra | Physician Assistant | 141 W Elm St, Sedgwick County Detention Facility, Wichita, KS 67203-3848 | 2007-06-13 |
| 1194888602 | Vicki L Gromala | Physician Assistant | 1861 N. Road Road, Suite 105, Wichita, KS 67206-1264 | 2006-12-18 |
| Find all providers in WICHITA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.