Provider Demographics
NPI:1699530402
Name:GRIMMICK, ASHLEY LYNNE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNNE
Last Name:GRIMMICK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 WOODOLIVE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-8770
Mailing Address - Country:US
Mailing Address - Phone:518-281-9288
Mailing Address - Fax:
Practice Address - Street 1:1731 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2624
Practice Address - Country:US
Practice Address - Phone:518-281-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353289363LF0000X
SC30294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily