Provider Demographics
NPI:1669915203
Name:JARRETT-GRAHAM, ANNETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:JARRETT-GRAHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MICHAEL F ST
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1232
Mailing Address - Country:US
Mailing Address - Phone:917-559-2923
Mailing Address - Fax:
Practice Address - Street 1:55 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2501
Practice Address - Country:US
Practice Address - Phone:347-761-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340714363LF0000X
NY403590363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily