Healthcare Provider Details

I. General information

NPI: 1265242986
Provider Name (Legal Business Name): GRACE KATHERINE BEEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 N 5TH ST
TERRE HAUTE IN
47809-6052
US

IV. Provider business mailing address

18234 GILMORE DR
SOUTH BEND IN
46637-6052
US

V. Phone/Fax

Practice location:
  • Phone: 812-237-3883
  • Fax:
Mailing address:
  • Phone: 574-298-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: