Provider Demographics
NPI:1548443567
Name:GRACE MEDICAL SERVICES, PLLC
Entity type:Organization
Organization Name:GRACE MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:859-797-1112
Mailing Address - Street 1:PO BOX 4661
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40544-4661
Mailing Address - Country:US
Mailing Address - Phone:859-797-1112
Mailing Address - Fax:859-381-9750
Practice Address - Street 1:113 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1463
Practice Address - Country:US
Practice Address - Phone:859-797-1112
Practice Address - Fax:859-381-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4344-P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty