Healthcare Provider Details

I. General information

NPI: 1457684490
Provider Name (Legal Business Name): CARRIE LYN GRAHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 W BASELINE RD STE 140
TEMPE AZ
85283-1065
US

IV. Provider business mailing address

2500 W UTOPIA RD STE 100
PHOENIX AZ
85027-4172
US

V. Phone/Fax

Practice location:
  • Phone: 602-777-6000
  • Fax: 602-438-6550
Mailing address:
  • Phone: 602-777-6000
  • Fax: 602-438-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4484
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: