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General NPI Number Information
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NPI Number | 1891306106
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Entity Type | Individual
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Provider Name | GRACE HORRALL PA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1260 CITY CENTER DR
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City | CARMEL
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State | IN
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Zip | 46032-3810
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Country | US
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Telephone | 463-333-8426
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Fax |
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Provider Business Mailing Address
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Address Line | 3346 EDEN VILLAGE PL
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City | CARMEL
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State | IN
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Zip | 46033-3014
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Country | US
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Telephone | 317-509-3692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10003232A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-10904
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License Number State | NC
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