Individual provider Active NPI

Roslyn A Grimsley, APN

  • Nurse Practitioner
  • Fort Smith, AR
National Provider Identifier
1093088023
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A03640 Issued in AR
Practice address
612 S 12TH St
Fort Smith, AR 72901-4702
Phone
(479) 785-2431
NPI assigned
Feb 22, 2012
Last updated
Mar 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A03640 AR Primary

Addresses

Primary practice location

612 S 12TH St
Fort Smith, AR 72901-4702

Mailing address

612 S 12TH St
Fort Smith, AR 72901-4702
Phone (479) 785-2431

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rgrimsley222413@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120411000134 AR Practitioner - Nurse Practitioner 8729249271 Reassigns benefits to 1 organization
I20151024000159 TX Practitioner - Nurse Practitioner 8729249271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

1575
Suite 30
Mesquite, TX 75150-6905
Phone (469) 800-2800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A03640ARMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Aug 17, 2015 Accepting new patients
Healthtexas Provider Network CurrentSince Aug 17, 2015 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Nov 5, 2018 Accepting new patients
Healthtexas Provider Network Current Accepting new patients

Locations

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

1575 Interstate 30
Mesquite, TX 75150
Phone (469) 800-2800

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1093088023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 S 12TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729014702",
            "telephone_number": "479-785-2431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 S 12TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729014702",
            "telephone_number": "479-785-2431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMSLEY",
        "first_name": "ROSLYN",
        "middle_name": "A",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-22",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A03640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgrimsley222413@direct.sw.org",
            "affiliation": "N",
            "address_1": "1575 I 30",
            "city": "Mesquite",
            "state": "TX",
            "country_code": "US",
            "postal_code": "751506905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.