Provider Demographics
NPI:1174989792
Name:GRAHAM, ELYSA C (DNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ELYSA
Middle Name:C
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:MRS
Other - First Name:ELYSA
Other - Middle Name:C
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9311 JW CLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5411
Mailing Address - Country:US
Mailing Address - Phone:704-412-2802
Mailing Address - Fax:336-203-2092
Practice Address - Street 1:1914 J N PEASE PL STE 144
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4504
Practice Address - Country:US
Practice Address - Phone:704-412-2802
Practice Address - Fax:336-203-2092
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009266363LG0600X, 363LP2300X, 363LF0000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty