Provider Demographics
NPI:1801348321
Name:GRAVES, REGINALD CARL (FNP)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:CARL
Last Name:GRAVES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SOUTH IH 35
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513
Mailing Address - Country:US
Mailing Address - Phone:254-939-2100
Mailing Address - Fax:254-939-2334
Practice Address - Street 1:3500 SOUTH IH 35
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513
Practice Address - Country:US
Practice Address - Phone:254-939-2100
Practice Address - Fax:254-939-2334
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2018020811363LP0808X
TXAP132295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health