Grace Family Practice Clinic, P.C.
NPI 1083124671ActiveOrganization· Family Medicine· Dyersburg, TN
Family Medicine in Dyersburg, Tennessee, registered in NPPES in October 2017. The authorized official on file is Monique Casey-Bolden, M.D., President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1083124671 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 9, 2017 |
| Last updated in NPPES | Oct 9, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | MD35727 | TN |
| Family Medicine | 207Q00000X | MD25289 | TN |
| Nurse Practitioner, Family | 363LF0000X | APN13637 | TN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TN) |
|---|
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