Provider Demographics
NPI:1861559692
Name:GRAHAM, JANET S (ANP)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:SUE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:26228 AL HIGHWAY 251
Mailing Address - Street 2:
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-3126
Mailing Address - Country:US
Mailing Address - Phone:256-423-8661
Mailing Address - Fax:
Practice Address - Street 1:PULASKI PAIN MANAGEMENT & ADULT HEALTH CARE
Practice Address - Street 2:304 EAST JEFFERSON ST
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:256-423-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner