Provider Demographics
NPI:1033328471
Name:GRAVES, CHERRY ELIZABETH (FNP-C, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:ELIZABETH
Last Name:GRAVES
Suffix:
Gender:F
Credentials:FNP-C, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14231 SEAWAY RD
Mailing Address - Street 2:SUITE 3004
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4628
Mailing Address - Country:US
Mailing Address - Phone:228-206-1905
Mailing Address - Fax:228-206-1917
Practice Address - Street 1:14231 SEAWAY RD
Practice Address - Street 2:SUITE 3004
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4628
Practice Address - Country:US
Practice Address - Phone:228-206-1905
Practice Address - Fax:228-206-1917
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866332363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR866332OtherNP LICENSE NUMBER
MS12195088OtherCAQH ID