Provider Demographics
NPI:1902324338
Name:GRAVES, ASHLEY C
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:C
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121
Mailing Address - Country:US
Mailing Address - Phone:205-625-3332
Mailing Address - Fax:205-625-3342
Practice Address - Street 1:2345 2ND AVE E
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-3221
Practice Address - Country:US
Practice Address - Phone:205-625-3332
Practice Address - Fax:205-625-3342
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148608363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily