Provider Demographics
NPI:1922545946
Name:GRAHAM, KATIE (NP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7259 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4806
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:2797 NC 55 HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6206
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012797363LF0000X
NH112004-23363LF0000X
KS53-83309-102363LF0000X
FLAPRN11032927363LF0000X
VT101.0137113363LF0000X
KY4022458363LF0000X
NC5019924363LF0000X
SC28644363LF0000X
MDAC005774363LF0000X
VA0024189921363LF0000X
OH020416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily