Provider Demographics
NPI:1285825034
Name:GRAVES, MONICA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIRCLE
Mailing Address - Street 2:SUITE 565
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4888
Mailing Address - Country:US
Mailing Address - Phone:502-895-1611
Mailing Address - Fax:502-895-1633
Practice Address - Street 1:4010 DUPONT CIRCLE
Practice Address - Street 2:SUITE 565
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4888
Practice Address - Country:US
Practice Address - Phone:502-895-1611
Practice Address - Fax:502-895-1633
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5038P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100042870Medicaid
KYK118280Medicare PIN
ININ1793006Medicare PIN