MEDICARE: CHERYL V FACEY-GRAHAM NP

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	71001633A	IN
2	363LF0000X	Family Nurse Practitioner	71001633A	IN

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	:	1730377623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL V FACEY-GRAHAM NP

Provider Business Mailing Address
First Line	:	1201 N POST RD STE 4
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4225
Country	:	US
Telephone Number	:	317-405-8833
Fax Number	:	317-672-2398

Provider Business Practice Location Address
First Line	:	1201 N POST RD STE 4
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4225
Country	:	US
Telephone Number	:	317-405-8833
Fax Number	:	317-672-2398

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	11/19/2025

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