Provider Demographics
NPI:1376636357
Name:GRAHAM, ELIZABETH K (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KATHERINE
Other - Last Name:DILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4010 DUPONT CIR STE 379
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4838
Mailing Address - Country:US
Mailing Address - Phone:502-754-3723
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 379
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4838
Practice Address - Country:US
Practice Address - Phone:502-754-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013482363LF0000X
WV63137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA1994Medicare UPIN
SCAA19944887Medicare PIN