# BEAUTIFULLY GRACED LLC

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

## Provider details

- **NPI number:** 1811617863
- **Authorized official:** MRS. STEPHANIE DENISE JERNIGHAN (FOUNDER)
- **Authorized official phone:** (321) 220-0862

## Contact information

- **Practice address:** 2155 PALM BAY RD NE STE 7, PALM BAY, FL 32905-2907
- **Practice address phone:** (321) 220-0862
- **Mailing address:** 2155 PALM BAY RD NE STE 7, PALM BAY, FL 32905-2907
- **Mailing address phone:** (321) 220-0862

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | Yes |
| 171400000X | Health & Wellness Coach | — | — | Yes |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | — |

## Other

- **Enumeration date:** 08/30/2022
- **Last updated:** 01/11/2024