Provider Demographics
NPI:1770392367
Name:GENTLE GRACE
Entity type:Organization
Organization Name:GENTLE GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-517-4008
Mailing Address - Street 1:2216 SHADOWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7440
Mailing Address - Country:US
Mailing Address - Phone:405-691-8600
Mailing Address - Fax:405-691-8601
Practice Address - Street 1:2216 SHADOWLAKE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7440
Practice Address - Country:US
Practice Address - Phone:405-691-8600
Practice Address - Fax:405-691-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty