Provider Demographics
NPI:1215583430
Name:ADAMS, GRACIE (FNP)
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 W SCHUNIOR ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-9490
Mailing Address - Country:US
Mailing Address - Phone:956-393-7376
Mailing Address - Fax:
Practice Address - Street 1:3804 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6681
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-296-3000
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08LR79201OtherBCBS
TX4025512-01Medicaid