Provider Demographics
NPI:1144652181
Name:GRAVES, JOANIE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:JOANIE
Middle Name:LYNN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 CYPRESS ST STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1348
Mailing Address - Country:US
Mailing Address - Phone:318-512-4112
Mailing Address - Fax:318-570-5903
Practice Address - Street 1:4624 CYPRESS ST STE 7
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-1348
Practice Address - Country:US
Practice Address - Phone:318-512-4112
Practice Address - Fax:318-570-5903
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07422363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2341766Medicaid