MEDICARE: JOANIE LYNN GRAVES APRN

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	363LP0200X	Pediatric Nurse Practitioner	AP07422	LA
2	363LF0000X	Family Nurse Practitioner	AP07422	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144652181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANIE LYNN GRAVES APRN

Provider Business Mailing Address
First Line	:	206 BELL LN
Second Line	:	STE C & D
City	:	WEST MONROE
State	:	LA
Zip	:	71291-1348
Country	:	US
Telephone Number	:	318-310-5840
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 BELL LANE
Second Line	:	SUITE C & D
City	:	WEST MONROE
State	:	LA
Zip	:	71291-1348
Country	:	US
Telephone Number	:	318-310-5840
Fax Number	:

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	06/19/2025

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