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General NPI Number Information
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NPI Number | 1861278962
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Entity Type | Individual
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Provider Name | SHANNON LEIGH GRAVES PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 8304 CREEDMOOR RD
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City | RALEIGH
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State | NC
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Zip | 27613-1697
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Country | US
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Telephone | 919-870-8409
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 MANOR STONE WAY
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8899
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Country | US
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Telephone | 607-341-0159
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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 | GRAV-W91JR
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License Number State | NC
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