# GRACE MOUNTAIN MEDICAL, LLC

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

## Provider details

- **NPI number:** 1821645896
- **Authorized official:** TONYA RENEE SHEPHERD HATFIELD APRN (CO-OWNER)
- **Authorized official phone:** (606) 226-8677

## Contact information

- **Practice address:** 115 LEE AVE STE 101, PIKEVILLE, KY 41501-2047
- **Practice address phone:** (606) 727-5296
- **Mailing address:** 1235 SALTLICK RD, HUEYSVILLE, KY 41640-6653
- **Mailing address phone:** (606) 226-8677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/23/2019
- **Last updated:** 11/14/2024