Provider Demographics
NPI:1932262995
Name:GRAVES, ANGELA LINDA (APN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LINDA
Last Name:GRAVES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1326
Mailing Address - Country:US
Mailing Address - Phone:903-927-3782
Mailing Address - Fax:903-927-1764
Practice Address - Street 1:4077 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1509
Practice Address - Country:US
Practice Address - Phone:870-330-9200
Practice Address - Fax:870-330-9439
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562258363LW0102X
ARA02971 ANP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA002971OtherNP LICENSE
AR163110758Medicaid
AR7030013600OtherQUALCHOICE
ARP00398439OtherRAILROAD MEDICARE