Provider Demographics
NPI:1043760200
Name:GRAHAM, KATHLEEN (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MARKET ST. WEST TOWER
Mailing Address - Street 2:LM 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:215-985-2500
Mailing Address - Fax:267-765-2325
Practice Address - Street 1:1900 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122
Practice Address - Country:US
Practice Address - Phone:215-765-6690
Practice Address - Fax:215-765-6694
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60690424363LP2300X
PASP019911363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care