MEDICARE: GRACE MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1811656820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE MEDICAL LLC

Provider Business Mailing Address
First Line	:	5444 ELYSIAN FIELDS AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4222
Country	:	US
Telephone Number	:	504-376-4017
Fax Number	:	504-226-0892

Provider Business Practice Location Address
First Line	:	5444 ELYSIAN FIELDS AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4222
Country	:	US
Telephone Number	:	504-539-8364
Fax Number	:	504-226-0892

Authorized Official
Title or Position	:	OWNER
Name	:	MIKSHIRA MARIE MOSELY
Credential	:	APRN
Telephone Number	:	504-376-4017

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	10/25/2025

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