Healthcare Provider Details

I. General information

NPI: 1700798337
Provider Name (Legal Business Name): GRACE MEDICAL WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N STOCKTON HILL RD STE 101
KINGMAN AZ
86401-6232
US

IV. Provider business mailing address

1115 N STOCKTON HILL RD STE 101
KINGMAN AZ
86401-6232
US

V. Phone/Fax

Practice location:
  • Phone: 928-263-1481
  • Fax: 928-307-7688
Mailing address:
  • Phone: 928-263-1481
  • Fax: 928-307-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANNI OWENS
Title or Position: OWNER
Credential:
Phone: 928-715-4783