Provider Demographics
NPI:1154787398
Name:GRAVES, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 US HWY 75 S,SUITE 300
Mailing Address - Street 2:ATTN. BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:806-351-7600
Mailing Address - Fax:806-351-7546
Practice Address - Street 1:1900 SE 34TH AVENUE UNIT 1800
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-5555
Practice Address - Country:US
Practice Address - Phone:806-351-7540
Practice Address - Fax:806-351-7546
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808631363LF0000X
TXAP130442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX478072ZHHLMedicare PIN