Provider Demographics
NPI:1083085898
Name:GRAVES, HOLLY DAWN (APRN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:DAWN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:DAWN
Other - Last Name:WILT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3252 E DOUGLAS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3354
Mailing Address - Country:US
Mailing Address - Phone:316-687-3275
Mailing Address - Fax:833-907-2276
Practice Address - Street 1:3252 E DOUGLAS AVE STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3354
Practice Address - Country:US
Practice Address - Phone:316-687-3275
Practice Address - Fax:833-907-2276
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017419363LF0000X
KS53-76970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily