Provider Demographics
NPI:1619162518
Name:GRAVES, DAWN L (MSN, RN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10134 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:ORRICK
Mailing Address - State:MO
Mailing Address - Zip Code:64077-8049
Mailing Address - Country:US
Mailing Address - Phone:816-288-5164
Mailing Address - Fax:
Practice Address - Street 1:197 N MCCLEARY RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-8490
Practice Address - Country:US
Practice Address - Phone:816-922-2970
Practice Address - Fax:816-637-2480
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111885363L00000X
KS1497663091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00631991OtherRAILROAD MEDICARE PIN
MOP00631991OtherRAILROAD MEDICARE PIN
MOMA1038005Medicare PIN
MOX93000035Medicare PIN
KSKA1093003Medicare PIN