Grimes-Mallard, Kristie Michelle

Grimes-Mallard, Kristie Michelle is an sole proprietor health care provider with primary practice located at 45 Dimock St , Roxbury MA 02119-1208. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Grimes-Mallard, Kristie Michelle can be contacted via phone (617) 442-8800.

Contact Information

Primary practice address
45 Dimock St Roxbury MA 02119-1208
Phone: (617) 442-8800
Fax: (617) 541-8334
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN2335640 Massachusetts
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN2335640 Massachusetts

Profile Details

NPI number 1730797077
LBN Legal business name Grimes-Mallard, Kristie Michelle
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 22nd, 2020
Last updated Nov 16th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730797077 NPPES
Massachusetts MEDICAID 110164451A

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