Individual
TERESSA L GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N/A
Contact information
Practice address
1742 N STATE ST, CLARKSDALE, MS 38614-6620
(662) 621-9850
(662) 621-9849
Mailing address
1742 N STATE ST, CLARKSDALE, MS 38614-6620
(662) 621-9850
(662) 621-9849
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
A0337768
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07078593
—
MS
Enumeration date
04/14/2010
Last updated
04/14/2010
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