Provider Demographics
NPI:1710414719
Name:GRAHAM, ARIEL DEL RIO (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:DEL RIO
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:ARIEL
Other - Middle Name:DEL RIO
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:254 HIGHWAY 3048
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3624
Mailing Address - Country:US
Mailing Address - Phone:318-728-8416
Mailing Address - Fax:318-728-8107
Practice Address - Street 1:256 HIGHWAY 3048
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3624
Practice Address - Country:US
Practice Address - Phone:318-728-2046
Practice Address - Fax:318-728-9371
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09421363LP2300X
LARN138403363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN138403OtherREGISTERED NURSE
LA2449761Medicaid
LAAP09421OtherADVANCED NURSE PRACTITIONER