MEDICARE: STEPHANIE NICOLE GRAVES FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	23503	TN

General Provider Information

NPI Number	:	1063925139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE GRAVES FNP-C

Provider Business Mailing Address
First Line	:	P O BOX 1000 DEPT 960
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	901-435-8550
Fax Number	:	901-516-0933

Provider Business Practice Location Address
First Line	:	2996 KATE BOND RD STE 305
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4063
Country	:	US
Telephone Number	:	901-300-2971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	06/27/2019

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