Provider Demographics
NPI:1730844838
Name:GENTRY, GRAHAM MICHAEL (FNP)
Entity type:Individual
Prefix:MR
First Name:GRAHAM
Middle Name:MICHAEL
Last Name:GENTRY
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:600 JEFFERSON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6987
Mailing Address - Country:US
Mailing Address - Phone:458-201-5074
Mailing Address - Fax:337-465-4604
Practice Address - Street 1:1755 SW BAKER ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9112
Practice Address - Country:US
Practice Address - Phone:971-900-4522
Practice Address - Fax:971-900-4503
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2025-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61241707363LF0000X
OR202109761NP207R00000X
OR202109761NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine