Provider Demographics
NPI:1427301241
Name:GRACE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:GRACE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNPBC
Authorized Official - Phone:307-235-3333
Mailing Address - Street 1:10265 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:82636
Mailing Address - Country:US
Mailing Address - Phone:307-235-3333
Mailing Address - Fax:307-266-5155
Practice Address - Street 1:1300 E A ST STE 201
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2260
Practice Address - Country:US
Practice Address - Phone:307-235-3333
Practice Address - Fax:307-266-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center