| Grace Family Practice Clinic, P.c. | |
|
1716 Parr Ave Ste D Dyersburg TN 38024-2074 | |
| (731) 288-0911 | |
| (731) 288-0065 |
| Full Name | Grace Family Practice Clinic, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 1716 Parr Ave Ste D, Dyersburg, Tennessee |
| Authorized Official Name and Position | Monique Casey-bolden (PRESIDENT) |
| Authorized Official Contact | 7312880911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Family Practice Clinic, P.c. 1716 Parr Ave Ste D Dyersburg TN 38024-2074 Ph: (731) 288-0911 | Grace Family Practice Clinic, P.c. 1716 Parr Ave Ste D Dyersburg TN 38024-2074 Ph: (731) 288-0911 |
| NPI Number | 1083124671 |
|---|---|
| Provider Enumeration Date | 10/09/2017 |
| Last Update Date | 10/09/2017 |
| Medicare PECOS PAC ID | 9537426044 |
|---|---|
| Medicare Enrollment ID | O20171207001940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083124671 | NPI | - | NPPES |
| Provider Name | Monique C Casey-bolden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710985858 PECOS PAC ID: 9537269477 Enrollment ID: I20070709000016 |
| Provider Name | Sandra Dennis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174768485 PECOS PAC ID: 3476713066 Enrollment ID: I20120319000475 |
| Provider Name | Rhiannon Michelle Andresen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831750843 PECOS PAC ID: 0648699439 Enrollment ID: I20200928002684 |
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