Healthcare Provider Details

I. General information

NPI: 1467310409
Provider Name (Legal Business Name): GRACELYN K RALSTON STUDENT NURSE TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 BEAVERVIEW DR
BRISTOL VA
24201-1837
US

IV. Provider business mailing address

685 BEAVERVIEW DR
BRISTOL VA
24201-1837
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-5916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230529
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: