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General NPI Number Information
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NPI Number | 1427301241
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Entity Type | Organization
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Legal Business Name | GRACE FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 1300 E A ST STE 201
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City | CASPER
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State | WY
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Zip | 82601-2260
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Country | US
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Telephone | 307-235-3333
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Fax | 307-266-5155
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Provider Business Mailing Address
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Address Line | 10265 CENTRAL PARK AVE
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City | EVANSVILLE
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State | WY
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Zip | 82636
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Country | US
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Telephone | 307-235-3333
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Fax | 307-266-5155
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. PEGGY LYN MURPHY
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Credential | FNP-C, PMHNPBC
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Telephone | 307-235-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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