Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3007960 | KY |
NPI | 1003259961 |
---|---|
Provider Name | Baeda Hodges Grimsley |
First Address | Louisville, KY 40205-3224 |
Second Address | Louisville, KY 40205-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 03/12/2018 |