GRACE PRIMARY CARE PLLC NPI 1679058804

NPI Information

  • NPI: 1679058804
  • Provider Name: GRACE PRIMARY CARE PLLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 18D0320395
  • Address: 6520 W HIGHWAY 22
    CRESTWOOD, KY
    ZIP 40014
  • Phone: (502) 241-8488

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NPI Details

GRACE PRIMARY CARE PLLC is a family nurse practitioner in Crestwood, KY. GRACE PRIMARY CARE PLLC NPI is 1679058804. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6520 W HIGHWAY 22
CRESTWOOD, KY
ZIP 40014
Phone: (502) 241-8488

The provider's authorized official is Renu B George .
The authorized official title is Owner and has the following contact phone number (502) 241-8488.

The CLIA number assigned to this NPI record is 18D0320395 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/3/2018 and was last updated on 6/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17100321490MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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