Provider Demographics
NPI:1245899269
Name:GRAVES, SARAI
Entity type:Individual
Prefix:
First Name:SARAI
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 S COLOMA WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8507
Mailing Address - Country:US
Mailing Address - Phone:661-863-8281
Mailing Address - Fax:
Practice Address - Street 1:222 N 2ND ST STE 311
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6131
Practice Address - Country:US
Practice Address - Phone:208-344-6080
Practice Address - Fax:208-344-6079
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL3256363A00000X
IDPA2624363A00000X
MSPA00511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant