Provider Demographics
NPI:1649743600
Name:GRAVEN, REBEKAH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:
Last Name:GRAVEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HEARTLAND RD STE 3800
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6201
Mailing Address - Country:US
Mailing Address - Phone:816-671-4812
Mailing Address - Fax:816-671-4822
Practice Address - Street 1:901 HEARTLAND RD STE 3800
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6201
Practice Address - Country:US
Practice Address - Phone:816-671-4800
Practice Address - Fax:816-671-4822
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005027638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily