Provider Demographics
NPI:1255652830
Name:GRAHAM, ROBERTA (AGPC-NP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AGPC-NP
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:WEYBRIGHT
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGPC-NP
Mailing Address - Street 1:8280 MONTGOMERY RD
Mailing Address - Street 2:SUIT 306
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6101
Mailing Address - Country:US
Mailing Address - Phone:888-393-9799
Mailing Address - Fax:937-531-7797
Practice Address - Street 1:8280 MONTGOMERY RD
Practice Address - Street 2:SUIT 306
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6101
Practice Address - Country:US
Practice Address - Phone:888-393-9799
Practice Address - Fax:937-531-7797
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-183333-COA1364SG0600X
OHCOA.15045-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MG2196827OtherDEA