MEDICARE: MS. KAREN L. GRAVES PMHNP, BC

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	23786.0844	WY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R853137	MS
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	23786.0844	WY

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
2	314347	OTHER	WY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336237833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN L. GRAVES PMHNP, BC

Provider Business Mailing Address
First Line	:	104 COAL SHADOW RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9550
Country	:	US
Telephone Number	:
Fax Number	:	307-242-5615

Provider Business Practice Location Address
First Line	:	104 COAL SHADOW RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9550
Country	:	US
Telephone Number	:	307-251-9392
Fax Number	:	307-242-5615

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	03/23/2026

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