Provider Demographics
NPI:1285609248
Name:GRAHAM, MICHELLE LYNN (ARNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:STOELZING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-540-7634
Mailing Address - Fax:918-540-7641
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:106-B
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6743
Practice Address - Country:US
Practice Address - Phone:918-540-7634
Practice Address - Fax:918-540-7641
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200038540AMedicaid
OK200468380WMedicaid
OK200468380WMedicaid
OK243504900Medicare PIN
OK243504900Medicare PIN