Healthcare Provider Details

I. General information

NPI: 1477896397
Provider Name (Legal Business Name): JILL E GRAVES ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 W DESCHUTES AVE STE 101
KENNEWICK WA
99336-7801
US

IV. Provider business mailing address

7131 W DESCHUTES AVE STE 101
KENNEWICK WA
99336-7801
US

V. Phone/Fax

Practice location:
  • Phone: 509-222-1260
  • Fax: 509-222-1264
Mailing address:
  • Phone: 509-222-1260
  • Fax: 509-222-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 60342794
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: