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GRACE FAMILY PRACTICE CLINIC, P.C.
NPI 1083124671
Family Medicine in Dyersburg, TN

Active since October 09, 2017CLIA 44D0921240 · Waiver
1716 PARR AVE STE D, DYERSBURG, TN 38024(731) 288-0911(731) 288-0065 Get Directions Write a Review

NPPES record last updated: October 9, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Grace Family Practice Clinic, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRACE FAMILY PRACTICE CLINIC, P.C. (NPI 1083124671) is a healthcare organization registered as a family medicine in Dyersburg, Tennessee and active in the NPI registry since October 2017. The organization holds a CLIA Waiver certificate valid through December 14, 2027 and lists Monique Casey-bolden, President, as its authorized official.

NPPES Registry Identity

NPI1083124671
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameGRACE FAMILY PRACTICE CLINIC, P.C.
Location Address1716 PARR AVE STE DDyersburg, TN 38024-2074
Mailing Address1716 Parr Ave Ste DDyersburg, TN 38024-2074 · (731) 288-0911 · Fax (731) 288-0065
Phone(731) 288-0911
Fax(731) 288-0065
Organization SubpartNo
Authorized OfficialMonique Casey-boldenPresident · (731) 288-0911
Enumeration DateOctober 9, 2017
✔ NPI 1083124671 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in TN · MD35727✔ Licensed in TN · MD25289
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License APN13637 (TN)
1716 PARR AVE STE D, Dyersburg, TN 38024
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D0921240

Grace Family Practice Clinic · Dyersburg, TN
Active · expires Dec 14, 2027
CLIA Number44D0921240
Laboratory TypePractitioner Other
Certificate Effective DateDecember 15, 2025
Certificate Expiration DateDecember 14, 2027
Laboratory DirectorDr. Monique C. Casey-Bolden
Laboratory Phone(731) 288-0911
Laboratory LocationGrace Family Practice Clinic1937 Cook St, Dyersburg, TN 38024
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FAMILY CARE, P.C.
Family Medicine
1716 PARR AVE STE D
DYERSBURG, TN 38024
Dyer County (731) 288-0911

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grace Family Practice Clinic, P.C.'s NPI number?

The NPI number for Grace Family Practice Clinic, P.C. is 1083124671. It was assigned to this organization in the NPPES registry on October 9, 2017.

Where is Grace Family Practice Clinic, P.C. located?

Grace Family Practice Clinic, P.C. is located at 1716 Parr Ave Ste D, Dyersburg, TN 38024. The listed phone number is (731) 288-0911.

What is Grace Family Practice Clinic, P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Grace Family Practice Clinic, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D0921240) is associated with this NPI, valid through December 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Grace Family Practice Clinic, P.C. was last updated on October 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.