Provider Demographics
NPI:1093527632
Name:GRAHAM, KRISTINA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 TRUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4263
Mailing Address - Country:US
Mailing Address - Phone:702-292-6054
Mailing Address - Fax:
Practice Address - Street 1:2255 RENAISSANCE DR STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6751
Practice Address - Country:US
Practice Address - Phone:702-901-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV866768363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health