Provider Demographics
NPI:1336562743
Name:GRAVES, MARY KATHLEEN VAUGHAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHLEEN VAUGHAN
Last Name:GRAVES
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7001 FOREST AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-282-0831
Mailing Address - Fax:804-288-7135
Practice Address - Street 1:7001 FOREST AVE STE 400
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-282-0831
Practice Address - Fax:804-288-7135
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2023-01-11
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Provider Licenses
StateLicense IDTaxonomies
VA0110004468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant