Healthcare Provider Details

I. General information

NPI: 1568461465
Provider Name (Legal Business Name): SHIRLEY MOHREN-GRAVES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date: 03/20/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

609 SPEYERS RD
SELAH WA
98942-1050
US

IV. Provider business mailing address

PO BOX 959
YAKIMA WA
98907-0959
US

V. Phone/Fax

Practice location:
  • Phone: 509-225-6311
  • Fax:
Mailing address:
  • Phone: 509-575-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70000139A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003693
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60869402
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number3003693
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number4960
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number3003693
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number700001394A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: