Provider Demographics
NPI:1861202418
Name:MIKELS, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MIKELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 PARK WEST BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4303
Mailing Address - Country:US
Mailing Address - Phone:865-407-2301
Mailing Address - Fax:
Practice Address - Street 1:9314 PARK WEST BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4303
Practice Address - Country:US
Practice Address - Phone:865-407-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner