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General NPI Number Information
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NPI Number | 1124763685
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Entity Type | Organization
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Legal Business Name | GRACE VITALE WELLNESS, LLC
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 1400 N COIT RD STE 302
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City | MCKINNEY
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State | TX
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Zip | 75071-6656
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Country | US
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Telephone | 945-542-0218
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 N COIT RD STE 302
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City | MCKINNEY
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State | TX
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Zip | 75071-6656
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Country | US
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Telephone | 945-542-0218
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | KATHERINE GRACE GRIMMETT
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Credential | MSN, APRN, FNP-C
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Telephone | 945-542-0218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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