Provider Demographics
NPI:1144291303
Name:GRAHAM, ASHLEE M (PA-C, CAQ PSYCH)
Entity type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C, CAQ PSYCH
Other - Prefix:MS
Other - First Name:ASHLEE
Other - Middle Name:M
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2990 N SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3700
Mailing Address - Country:US
Mailing Address - Phone:918-342-2622
Mailing Address - Fax:918-342-2641
Practice Address - Street 1:8937 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6018
Practice Address - Country:US
Practice Address - Phone:918-872-9777
Practice Address - Fax:918-872-9779
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1331363AM0700X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00117429OtherMEDICARE RAILROAD
OK200020640AMedicaid
OK1061737OtherNCCPA - CAQ - PSYCH
OKQ05605Medicare UPIN