MEDICARE: MRS. ANDREA TAYLOR WILSON GRAF

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1487513859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA TAYLOR WILSON GRAF

Provider Business Mailing Address
First Line	:	107 AMERSON ORCHARD RD APT 305
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-8558
Country	:	US
Telephone Number	:	606-260-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	4185 WALT ROBERTSON RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1499
Country	:	US
Telephone Number	:	859-231-7066
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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