Provider Demographics
NPI:1699757138
Name:GRAVES, JENNIFER LYNN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIIONER
Mailing Address - Street 1:5906 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5110
Mailing Address - Country:US
Mailing Address - Phone:918-510-8927
Mailing Address - Fax:918-794-4778
Practice Address - Street 1:5906 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5110
Practice Address - Country:US
Practice Address - Phone:918-794-4777
Practice Address - Fax:918-794-4778
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28078821A363LA2200X
OKR0083557363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health