Provider Demographics
NPI:1457430613
Name:GRAVES, GINA B (NP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:B
Last Name:GRAVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:1609 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6420
Practice Address - Country:US
Practice Address - Phone:931-388-8802
Practice Address - Fax:931-490-2292
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3905894Medicaid
TN4162439OtherBCBST
TN3710089Medicaid
4189255OtherBCBST
TN1506769Medicaid
TN3732438Medicaid
TN3710089Medicaid
3710089Medicare PIN
TN4162439OtherBCBST
TN3732438Medicaid
TN3905894Medicare PIN
TN3732438Medicare PIN
CE0561Medicare PIN
TN3905894Medicaid