Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | R866332 | MS |
Y | 363LW0102X | Nurse Practitioner - Women's Health | R866332 | MS |
NPI | 1033328471 |
---|---|
Provider Name | Cherry Elizabeth Graves |
First Address | Gulfport, MS 39503-4628 |
Second Address | Gulfport, MS 39503-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 03/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12195088 | CAQH ID (01) | MS |
R866332 | NP LICENSE NUMBER (01) | MS |