Provider Demographics
NPI:1225695331
Name:GRAVES, LINDA KELLY (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KELLY
Last Name:GRAVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13869
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3869
Mailing Address - Country:US
Mailing Address - Phone:610-340-3530
Mailing Address - Fax:610-337-0185
Practice Address - Street 1:625 CLARK AVE STE 17B
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:215-654-1544
Practice Address - Fax:215-654-1543
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN225600L163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN225600LOtherLICENSE