Healthcare Provider Details

I. General information

NPI: 1922933795
Provider Name (Legal Business Name): GRACE LILLIE MCKIERNAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W COLLEGE ST
GRAPEVINE TX
76051-3565
US

IV. Provider business mailing address

2403 N WASHINGTON AVE APT 434
DALLAS TX
75204-3769
US

V. Phone/Fax

Practice location:
  • Phone: 817-481-1588
  • Fax:
Mailing address:
  • Phone: 610-844-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number126536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: