Healthcare Provider Details

I. General information

NPI: 1255652830
Provider Name (Legal Business Name): ROBERTA GRAHAM AGPC-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBI WEYBRIGHT GRAHAM AGPC-NP

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 MONTGOMERY RD SUIT 306
CINCINNATI OH
45236-6101
US

IV. Provider business mailing address

8280 MONTGOMERY RD SUIT 306
CINCINNATI OH
45236-6101
US

V. Phone/Fax

Practice location:
  • Phone: 888-393-9799
  • Fax: 937-531-7797
Mailing address:
  • Phone: 888-393-9799
  • Fax: 937-531-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberRN-183333-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.15045-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: