MEDICARE: KRISTINA GRAHAM APRN-CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	866768	NV

General Provider Information

NPI Number	:	1093527632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA GRAHAM APRN-CNP

Provider Business Mailing Address
First Line	:	10628 TRUSSELL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4263
Country	:	US
Telephone Number	:	702-292-6054
Fax Number	:	702-434-3530

Provider Business Practice Location Address
First Line	:	2255 RENAISSANCE DR STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6751
Country	:	US
Telephone Number	:	702-901-4880
Fax Number	:	702-434-3530

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	11/04/2025

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