Provider Demographics
NPI:1144277351
Name:GRAVES, VALORIE JEAN (PA)
Entity type:Individual
Prefix:MRS
First Name:VALORIE
Middle Name:JEAN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:2001 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2107
Practice Address - Country:US
Practice Address - Phone:405-262-2114
Practice Address - Fax:405-262-2306
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK374363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106580AMedicaid
OKS59607Medicare UPIN
OK249603403Medicare ID - Type Unspecified