Provider Demographics
NPI:1831443993
Name:GRAHAM, MEKI JACOBS (ANP-C)
Entity type:Individual
Prefix:
First Name:MEKI
Middle Name:JACOBS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3634
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:
Practice Address - Street 1:206 WARRIOR TRL
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2307
Practice Address - Country:US
Practice Address - Phone:910-599-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146393363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831443993Medicaid
SCNP3755Medicaid
NCNCA392CMedicare PIN
NCNCA392EMedicare PIN
SCNP3755Medicaid
NC1831443993Medicaid