MEDICARE: KEYNA GRAHAM-HEINE ARNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60961405	WA
2	163W00000X	Registered Nurse	RN00166072	WA

General Provider Information

NPI Number	:	1841796604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYNA GRAHAM-HEINE ARNP

Provider Business Mailing Address
First Line	:	9116 GRAVELLY LAKE DR SW STE 107
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-364-6054
Fax Number	:	833-764-4009

Provider Business Practice Location Address
First Line	:	9116 GRAVELLY LAKE DR SW STE 107
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-364-6054
Fax Number	:	833-764-4009

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	01/27/2026

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