Healthcare Provider Details

I. General information

NPI: 1265351308
Provider Name (Legal Business Name): BROOKE OLIVIA GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 HIGHWAY 52
ELDON MO
65026-5370
US

IV. Provider business mailing address

2751 HIGHWAY 52
ELDON MO
65026-5370
US

V. Phone/Fax

Practice location:
  • Phone: 573-692-0342
  • Fax:
Mailing address:
  • Phone: 573-692-0342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: