Healthcare Provider Details

I. General information

NPI: 1427301241
Provider Name (Legal Business Name): GRACE FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E A ST STE 201
CASPER WY
82601-2260
US

IV. Provider business mailing address

10265 CENTRAL PARK AVE
EVANSVILLE WY
82636
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-3333
  • Fax: 307-266-5155
Mailing address:
  • Phone: 307-235-3333
  • Fax: 307-266-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. PEGGY LYN MURPHY
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C, PMHNPBC
Phone: 307-235-3333