MEDICARE: SHANNON GRAVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0995563	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0995563	CO

General Provider Information

NPI Number	:	1376169763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GRAVES

Provider Business Mailing Address
First Line	:	9362 GRAND CORDERA PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:	719-345-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	9362 GRAND CORDERA PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:	719-345-0429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	09/01/2025

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Directions to “ SHANNON GRAVES ” Practice Location

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