Provider Demographics
NPI:1053496489
Name:GRAHAM ALEXANDER, MONA JILL (FNP-BC, CNOR, RNFA)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:JILL
Last Name:GRAHAM ALEXANDER
Suffix:
Gender:F
Credentials:FNP-BC, CNOR, RNFA
Other - Prefix:MRS
Other - First Name:MONA
Other - Middle Name:JILL
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6169 HWY 98 W
Mailing Address - Street 2:SUITE 30
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-602-5000
Mailing Address - Fax:601-602-5003
Practice Address - Street 1:6169 HWY 98 W
Practice Address - Street 2:SUITE 30
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-602-5000
Practice Address - Fax:601-602-5003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856316163WR0006X
MSR865316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant