Grace Family Medical, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

GRACE FAMILY MEDICAL, LLC

Doing business as

Rehydration Station and Aesthetics

Practice address

5100 S Thompson St Ste 214
Springdale, AR 72764-6941

Phone

(479) 329-1194

Fax

(479) 223-5365

NPI assigned

Feb 12, 2022

Last updated

Feb 20, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kellie Ann Chacanaca, APRNNPI 1487004461

Title

Owner/Member

Phone

(479) 329-1194

Specialties & licenses 1

Addresses

Other names 1

• Rehydration Station and Aesthetics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kellie Ann Chacanaca, APRN

  • Family Nurse Practitioner
  • Rogers, AR
  • NPI 1487004461
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1255086898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 S THOMPSON ST STE 214",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727646941",
            "telephone_number": "479-329-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 S THOMPSON ST STE 214",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727646941",
            "telephone_number": "479-329-1194",
            "fax_number": "479-223-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE FAMILY MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-12",
        "last_updated": "2024-02-20",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "CHACANACA",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "479-329-1194",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehydration Station and Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven Corbin Gorgas, DPT
• Megan Rose Gorham, PA-C
• Bailey Ann Gotte
• Bailey Gould
• Staci Marie Graber, APN
• Grace Haven Ministries
• Maria T Grace, LCSW
• Sally L Grace, A.P.N.
• Caisa Gracie, LMSW
• Alicia Leah Graham, MHPP

• Family Nurse Practitioner in Springdale, AR
• Providers in Springdale, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.