Provider Demographics
NPI:1417380700
Name:GRAVELY, FALLON LAWS (RN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:FALLON
Middle Name:LAWS
Last Name:GRAVELY
Suffix:
Gender:F
Credentials:RN, CNP
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 571
Mailing Address - Street 2:
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016-0571
Mailing Address - Country:US
Mailing Address - Phone:505-658-1549
Mailing Address - Fax:
Practice Address - Street 1:1330 SAN PEDRO DR NE STE 205J
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6749
Practice Address - Country:US
Practice Address - Phone:505-658-1561
Practice Address - Fax:505-445-0774
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-83568163W00000X
NMCNP-03186363L00000X, 363LP0808X
NMCNP03186363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology