Most Relevant Information
Provider Data
| NPI Number: | 1003597774 |
| Provider Name: | TYRIEKA GRACE |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/26/2023 |
| Last Updated: | 07/26/2023 |
Provider Practice Location
1628 E PAGE AVE
MALVERN
AR
721044524
Practice Location Phone/Fax
| Phone: | 5013153344 |
| Fax: |
Provider Mailing Location
PO BOX 1589
BENTON
AR
720181589
Provider Mailing Phone/Fax
| Phone: | 5013153344 |
| Fax: |