Provider Demographics
NPI:1588207138
Name:GRAHAM, KRISTEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 W KRISTAL WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5772
Mailing Address - Country:US
Mailing Address - Phone:602-291-2612
Mailing Address - Fax:
Practice Address - Street 1:13575 W INDIAN SCHOOL RD STE 200
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4906
Practice Address - Country:US
Practice Address - Phone:623-512-4310
Practice Address - Fax:623-512-4311
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ235852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program