Provider Demographics
NPI:1215780341
Name:GRAVES, BROOKLIN CIARA JOHNSON (CRNP)
Entity type:Individual
Prefix:
First Name:BROOKLIN
Middle Name:CIARA JOHNSON
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 QUINTARD AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5714
Mailing Address - Country:US
Mailing Address - Phone:256-231-2552
Mailing Address - Fax:
Practice Address - Street 1:1031 QUINTARD AVE STE 1A
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5714
Practice Address - Country:US
Practice Address - Phone:256-231-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-170081363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care