Individual
DR. AIMEE RUSSELL GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2 TRILLIUM WAY, SUITE 306, CORBIN, KY 40701-8490
(606) 526-4070
(606) 526-4072
Mailing address
PO BOX 1325, CORBIN, KY 40702-1325
(606) 526-8131
(606) 528-8661
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
03619
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12628450
CAQH
—
05
—
7100265930
—
KY
01
—
P01329276
RR MEDICARE
KY
Enumeration date
03/29/2010
Last updated
03/07/2023
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