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General NPI Number Information
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NPI Number | 1881428977
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Entity Type | Organization
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Legal Business Name | GRAPELAND EMERGENT CARE
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Dates
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Enumeration Date | 08/29/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 205 CHURCH ST
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City | GRAPELAND
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State | TX
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Zip | 75844-2151
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Country | US
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Telephone | 936-228-3244
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Fax | 936-687-5024
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Provider Business Mailing Address
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Address Line | 1887 FM 231
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City | LOVELADY
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State | TX
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Zip | 75851-3408
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Country | US
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Telephone | 936-228-3244
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Fax | 936-687-5024
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Authorized Official
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Title or Position | FNP., OWNER
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Name | CHRISSY SHUPAK
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Credential | FNP
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Telephone | 936-228-3244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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