Individual
KELLY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
213 RIVER WALK PKWY, CHESAPEAKE, VA 23320-6893
(757) 983-1777
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 689-5104
(757) 689-2717
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024173581
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720530629
MULTIPLAN
VA
05
—
1720530629
—
NC
05
—
1720530629
—
VA
Enumeration date
10/26/2016
Last updated
01/05/2021
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