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General NPI Number Information
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NPI Number | 1710854518
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Entity Type | Individual
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Provider Name | SHONI LAVON GRAVES PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 25277 RIDGE LN
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City | JULIAETTA
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State | ID
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Zip | 83535-6113
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Country | US
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Telephone | 208-816-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 25277 RIDGE LN
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City | JULIAETTA
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State | ID
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Zip | 83535-6113
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Country | US
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Telephone | 208-816-6700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4071685
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License Number State | ID
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