Provider Demographics
NPI:1942280623
Name:GRAVES, JENNIFER M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2781 TRICOM ST
Mailing Address - Street 2:PALMETTO PEDIATRICS, PA
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9170
Mailing Address - Country:US
Mailing Address - Phone:843-797-5600
Mailing Address - Fax:843-572-4872
Practice Address - Street 1:2781 TRICOM ST
Practice Address - Street 2:PALMETTO PEDIATRICS, PA
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9170
Practice Address - Country:US
Practice Address - Phone:843-797-5600
Practice Address - Fax:843-572-4872
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1089363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical