Provider Demographics
NPI:1477896397
Name:GRAVES, JILL E (ARNP-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:GRAVES
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 W DESCHUTES AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7801
Mailing Address - Country:US
Mailing Address - Phone:509-222-1260
Mailing Address - Fax:509-222-1264
Practice Address - Street 1:7131 W DESCHUTES AVE STE 101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7801
Practice Address - Country:US
Practice Address - Phone:509-222-1260
Practice Address - Fax:509-222-1264
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60342794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily