{
"Npi": {
"NPI": "1245899269",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GRAVES",
"FirstName": "SARAI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2136 S COLOMA WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83712-8507",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "661-863-8281",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "222 N 2ND ST STE 311",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83702-6131",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-344-6080",
"PracticeLocationAddressFaxNumber": "208-344-6079",
"EnumerationDate": "06/12/2019",
"LastUpdateDate": "10/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "TL3256",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA2624",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA00511",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}