Provider Demographics
NPI:1528899663
Name:GRAVES, JAQUINTA M (PA)
Entity type:Individual
Prefix:
First Name:JAQUINTA
Middle Name:M
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1075 E BETTERAVIA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7023
Mailing Address - Country:US
Mailing Address - Phone:805-621-7714
Mailing Address - Fax:
Practice Address - Street 1:1110 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3932
Practice Address - Country:US
Practice Address - Phone:337-364-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-11-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699049262OtherHULIN URGENT CARE SERVICES LLC