Organization
GRACE PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENU B GEORGE NP (OWNER)
(502) 241-8488
Entity
Organization
Contact information
Practice address
6520 W HIGHWAY 22, CRESTWOOD, KY 40014
(502) 241-8488
Mailing address
6520 W HIGHWAY 22, CRESTWOOD, KY 40014-9305
(502) 241-8488
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100321490
—
KY
Enumeration date
10/03/2018
Last updated
06/11/2019
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