Provider Demographics
NPI:1649243619
Name:GRAHAM, JULIE A (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 WHITE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2667
Mailing Address - Country:US
Mailing Address - Phone:816-765-3888
Mailing Address - Fax:816-763-8306
Practice Address - Street 1:13010 WHITE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2667
Practice Address - Country:US
Practice Address - Phone:816-765-3888
Practice Address - Fax:816-763-8306
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429098114Medicaid
821442751Medicare ID - Type Unspecified
MO429098114Medicaid