GRACE PRIMARY CARE PLLC
NPI 1679058804
Nurse Practitioner - Family in Crestwood, KY

Active since October 03, 2018CLIA 18D0320395 · Waiver
6520 W HIGHWAY 22, CRESTWOOD, KY 40014(502) 241-8488 Get Directions Write a Review

NPPES record last updated: June 11, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 11, 2019, Jun 7, 2019, Nov 16, 2018 and 1 more (4 updates tracked since 2018).

About Grace Primary Care Pllc NPPES

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

GRACE PRIMARY CARE PLLC (NPI 1679058804) is a healthcare organization registered as a family in Crestwood, Kentucky and active in the NPI registry since October 2018. The organization holds a CLIA Waiver certificate valid through August 1, 2027, maintains a secondary practice location in Crestwood, and lists Renu B George, Owner, as its authorized official.

NPPES Registry Identity

NPI1679058804
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameGRACE PRIMARY CARE PLLC
Location Address6520 W HIGHWAY 22Crestwood, KY 40014
Mailing Address6520 W Highway 22Crestwood, KY 40014-9305 · (502) 241-8488
Organization SubpartNo
Authorized OfficialRenu B GeorgeOwner · (502) 241-8488
Enumeration DateOctober 3, 2018
Last NPPES UpdateJune 11, 20194 updates tracked since enumeration
NPI 1679058804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
6520 W HIGHWAY 22, Crestwood, KY 40014

Secondary Practice Location 1

Location 16520 W Highway 22Crestwood, KY 40014 · Phone (502) 241-8488

Other Identifiers 1

Medicaid7100321490KY

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

Accepted Insurance

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 18D0320395

Grace Primary Care, PLLC · Crestwood, KY
Active · expires Aug 1, 2027
CLIA Number18D0320395
Laboratory TypeCommunity Clinic
Certificate Effective DateAugust 2, 2025
Certificate Expiration DateAugust 1, 2027
Laboratory DirectorMr. Renu George
Laboratory Phone(502) 241-8488
Laboratory LocationGrace Primary Care, PLLC6520 West Highway 22, Crestwood, KY 40014
CLIA data matches this NPI record on: Address 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 Medicine
6520 W HIGHWAY 22
CRESTWOOD, KY 40014

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 Primary Care PLLC's NPI number?

The NPI number for Grace Primary Care PLLC is 1679058804. It was assigned to this organization in the NPPES registry on October 3, 2018.

Where is Grace Primary Care PLLC located?

Grace Primary Care PLLC is located at 6520 W Highway 22, Crestwood, KY 40014. The listed phone number is (502) 241-8488.

What is Grace Primary Care PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Grace Primary Care PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D0320395) is associated with this NPI, valid through August 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Grace Primary Care PLLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health and Ambetter of Tennessee list Grace Primary Care PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Grace Primary Care PLLC was last updated on June 11, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.