Provider Demographics
NPI:1760025092
Name:GRAVES, MARY FRANCES (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-544-2188
Practice Address - Street 1:5580 INN RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-1904
Practice Address - Country:US
Practice Address - Phone:251-666-7413
Practice Address - Fax:251-666-7417
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL242341Medicaid
AL242790Medicaid
AL242269Medicaid
AL242349Medicaid
AL242369Medicaid
AL242791Medicaid
AL242342Medicaid
AL242534Medicaid
AL242694Medicaid