Individual
HEATHER GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2250
(859) 572-2326
Mailing address
PO BOX 18667, ERLANGER, KY 41018-0667
(513) 312-2247
(859) 572-2326
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3010256
KY
363L00000X
Nurse Practitioner
COA.15192NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100347370
—
KY
Enumeration date
10/23/2013
Last updated
06/02/2021
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