Provider Demographics
NPI:1073301719
Name:BONDURANT, GRACE (RN, APRN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:BONDURANT
Suffix:
Gender:
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8827 PEBBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2845
Mailing Address - Country:US
Mailing Address - Phone:443-878-6934
Mailing Address - Fax:
Practice Address - Street 1:555 WALNUT ST STE 150
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1314
Practice Address - Country:US
Practice Address - Phone:423-553-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000035321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily