Provider Demographics
NPI:1235331703
Name:GRAVES, PATRICIA S (NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:GRAVES
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DILLMONT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-6458
Mailing Address - Country:US
Mailing Address - Phone:614-839-3040
Mailing Address - Fax:614-839-3041
Practice Address - Street 1:55 DILLMONT DR
Practice Address - Street 2:STE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-6458
Practice Address - Country:US
Practice Address - Phone:614-839-3040
Practice Address - Fax:614-839-3041
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117351363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2044488Medicaid