# GRACE GYNECOLOGY & WELLNESS CORP APMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154083376
- **Authorized official:** MS. MIKA MARLAINE KING M.D. (PHYSICIAN/PRESIDENT OF CORP)
- **Authorized official phone:** (337) 654-4729

## Contact information

- **Practice address:** 200 BEAULLIEU DR STE 3B, LAFAYETTE, LA 70508-7230
- **Practice address phone:** (337) 522-7282
- **Practice address fax:** (337) 393-7057
- **Mailing address:** 200 BEAULLIEU DR STE 3B, LAFAYETTE, LA 70508-7230
- **Mailing address phone:** (337) 522-7282
- **Mailing address fax:** (337) 393-7057

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/06/2021
- **Last updated:** 01/12/2022