Healthcare Provider Details

I. General information

NPI: 1649243619
Provider Name (Legal Business Name): JULIE A GRAHAM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MISSION DR STE 320
JEFFERSON CITY MO
65109-9508
US

IV. Provider business mailing address

1706 W AGENCY RD
WEST BURLINGTON IA
52655-1667
US

V. Phone/Fax

Practice location:
  • Phone: 573-681-3249
  • Fax: 573-681-3679
Mailing address:
  • Phone: 319-768-5858
  • Fax: 319-752-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number142186
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG095717
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: