Provider Demographics
NPI:1316451735
Name:GRAHAM, BEVERLY DENISE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:DENISE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CROMWELL CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-7411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:708 S GRANT ST STE 15
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-5707
Practice Address - Country:US
Practice Address - Phone:912-309-3338
Practice Address - Fax:229-345-8290
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily