Provider Demographics
NPI:1891787420
Name:GRAVES, ANGELA K (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:GRAVES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N GREEN RIVER RD STE 510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1374
Mailing Address - Country:US
Mailing Address - Phone:812-303-4300
Mailing Address - Fax:812-303-4308
Practice Address - Street 1:3101 N. GREEN RIVER ROAD
Practice Address - Street 2:SUITE 620
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715
Practice Address - Country:US
Practice Address - Phone:812-303-4300
Practice Address - Fax:812-303-4308
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002061A231H00000X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200096620Medicaid
IN848470DMedicare ID - Type Unspecified