Healthcare Provider Details

I. General information

NPI: 1609195569
Provider Name (Legal Business Name): NATHAN ISAAC GRAFF NP-C, AT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 S NATIONAL AVE
SPRINGFIELD MO
65807-7305
US

IV. Provider business mailing address

1891 W RANCH RD
NIXA MO
65714-8262
US

V. Phone/Fax

Practice location:
  • Phone: 417-771-3147
  • Fax: 417-771-3256
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022002047
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: