Individual
MRS. ASHLEE M GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, CAQ PSYCH
Contact information
Practice address
8937 S GARNETT RD, BROKEN ARROW, OK 74012-6018
(918) 872-9777
(918) 872-9779
Mailing address
2990 N SIOUX AVE, CLAREMORE, OK 74017-3700
(918) 342-2622
(918) 342-2641
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1331
OK
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
1331
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1061737
NCCPA - CAQ - PSYCH
OK
05
—
200020640A
—
OK
01
—
P00117429
MEDICARE RAILROAD
OK
Enumeration date
01/27/2006
Last updated
01/25/2024
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