Provider Demographics
NPI:1861801565
Name:GRAHAM, JESSINA (APRN, C-NP)
Entity type:Individual
Prefix:
First Name:JESSINA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:APRN, C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 LANDMARK PL SUITE 215
Mailing Address - Street 2:#418
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1825
Mailing Address - Country:US
Mailing Address - Phone:405-824-1705
Mailing Address - Fax:405-307-6660
Practice Address - Street 1:2921 LANDMARK PL STE 215
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4248
Practice Address - Country:US
Practice Address - Phone:405-824-1705
Practice Address - Fax:608-299-3707
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100661363LF0000X, 163W00000X
WI14613-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty