KELLY GRAHAM (NPI# 1720530629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720530629 |
| Entity Type | Individual |
| Full Name | KELLY GRAHAM |
| Other Name | KELLY DAWN DEMARCO |
| Credential | FNP |
| Practice Address |
2075 Glenn Mitchell Dr Suite 500 Virginia Beach VA 23456-0179 |
| Mailing Address |
Po Box 936 Norfolk VA 23501-0936 |
| Practice Telephone | 7576895104 |
| Practice Fax Number | 7576892717 |
| Mailing Telephone | 7576895104 |
| Mailing Fax Number | 7576892717 |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2017-04-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
0024173581 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | TRICARE/CHAMPUS | 1720530629 | 01 |
| VA | VIRGINIA PREMIER HEALTH PLAN | 1720530629 | 01 |
| VA | HUMANA | 1720530629 | 01 |
| VA | USA MANAGED CARE | 1720530629 | 01 |
| NC | 1720530629 | 05 | |
| VA | MULTIPLAN | 1720530629 | 01 |
| VA | 1720530629 | 05 | |
| VA | OPTIMA HEALTH | 1720530629 | 01 |
| VA | CORVEL | 1720530629 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134669682 | Kelly Graham | Specialist/Technologist | 601 Custis Rd, Glenside, PA 19038-2013 | 2017-03-02 |
| 1649446774 | Kelly Ann Graham | Occupational Therapist | 161 Se 5th Ct, Pompano Beach, FL 33060-7164 | 2008-05-08 |
| 1447239629 | Kelly Leigh Graham | Optometrist | 113 N Plaza Ct, Van Buren, AR 72956-2269 | 2006-01-16 |
| 1396258232 | Kelly Marie Graham | Counselor | 2005 Ashland Ave, Toledo, OH 43620-1703 | 2017-11-14 |
| 1780031625 | Kelly Ann Graham | Physical Therapy Assistant | 1222 S Orange Ave, Orlando, FL 32806-1215 | 2016-05-20 |
| 1174915862 | Kelly Graham | Counselor | 5648 Friendship Ave, Pittsburgh, PA 15206-3610 | 2015-03-04 |
| 1750783981 | Kelly Graham | Speech-Language Pathologist | 1349 Empire Central Dr, Suite 516, Dallas, TX 75247-4066 | 2014-09-18 |
| 1417369240 | Kelly Graham | Massage Therapist | 10021 Holman Rd Nw, Seattle, WA 98177-4920 | 2014-05-28 |
| 1821410309 | Kelly Jean Graham | Behavioral Analyst | 780 Lynnhaven Pkwy Ste 400, Virginia Beach, VA 23452-7332 | 2014-01-17 |
| 1588093157 | Kelly Graham | Physician Assistant | 960 Johnson Ferry Rd, Ste 100, Atlanta, GA 30342-1631 | 2013-11-05 |
| Street Address |
2075 GLENN MITCHELL DR SUITE 500 |
| City | VIRGINIA BEACH |
| State | VA |
| Zip Code | 23456-0179 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639222797 | Melissa J Buchberg | Obstetrics & Gynecology | 2075 Glenn Mitchell Dr, Suite 410, Virginia Beach, VA 23456-0179 | 2007-01-19 |
| 1336692524 | Amber Lynn Sourbeer | Physician Assistant | 2075 Glenn Mitchell Dr, Ste 400, Virginia Beach, VA 23456-0179 | 2016-07-25 |
| 1790166692 | Melody Lynne Osborne | Physician Assistant | 2075 Glenn Mitchell Dr, Suite 512, Virginia Beach, VA 23456-0179 | 2015-06-16 |
| 1316284979 | Sentara Medical Group | Surgery | 2075 Glenn Mitchell Dr, Ste 506, Virginia Beach, VA 23456-0179 | 2013-01-15 |
| 1104186428 | Sentara Medical Group | Internal Medicine | 2075 Glenn Mitchell Dr, Ste 400, Virginia Beach, VA 23456-0179 | 2012-05-21 |
| 1467720763 | Sentara Medical Group | Surgery | 2075 Glenn Mitchell Dr, Ste 512, Virginia Beach, VA 23456-0019 | 2011-12-01 |
| 1619251089 | Sentara Medical Group | Surgery | 2075 Glenn Mitchell Dr, Ste 512a, Virginia Beach, VA 23456-0019 | 2011-10-04 |
| 1366774192 | Susan Edmondson Phillips | Genetic Counselor, MS | 2075 Glenn Mitchell Dr, Suite 500, Virginia Beach, VA 23456-0179 | 2010-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336679349 | Joelene Grandy | Contractor | 1892 Riverrock Arch, Virginia Beach, VA 23456 | 2017-06-13 |
| 1023568995 | Red Mill Pediatric Dentistry and Behl Orthodontics Pllc | Dentist | 2033 Fisher Arch, Ste 100, Virginia Beach, VA 23456 | 2016-10-04 |
| 1609235803 | Maria Teresa Olivas | Registered Nurse | 3212 Fluuanna Circle, Virginia Beach, VA 23456 | 2016-02-16 |
| 1326434747 | Catharine White Cartwright | Physician Assistant | 2501 James Madison Blvd, Virginia Beach, VA 23456 | 2015-04-13 |
| 1598153785 | Harris Teeter LLC | Pharmacy | 2105 Princess Anne Road, Suite 100, Virginia Beach, VA 23456 | 2014-12-23 |
| 1881034023 | Kimberly Ann Benson | Dentist | 2105 Princess Anne Road, Suite 108, Virginia Beach, VA 23456 | 2013-07-02 |
| 1124378450 | Phyllis A. Wilson | Psychologist | 1249 Eagle Way, Virginia Beach, VA 23456 | 2012-09-13 |
| 1033477807 | Wolfgang J. Bay | Dentist | 1625 Salem Road #101, Virginia Beach, VA 23456 | 2012-04-30 |
| 1881974475 | Virginia Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2232 General Booth Blvd, Virginia Beach, VA 23456 | 2011-08-26 |
| 1780988857 | Casey Snyder | Dentist | 2484 North Landing Road, Virginia Beach, VA 23456 | 2011-01-05 |
| Find all providers in zip 23456 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881294783 | Amy K Volk | Nurse Practitioner | 272 Bendix Rd Ste 100, Virginia Beach, VA 23452-1380 | 2020-10-29 |
| 1407462575 | Jody Lynn Glass | Nurse Practitioner | 1567 Back Bay Landing Rd, Virginia Beach, VA 23457-1338 | 2020-09-23 |
| 1063027373 | Karen Elaine Callaway | Nurse Practitioner | 937 Sunnyside Dr, Virginia Beach, VA 23464-2128 | 2020-09-14 |
| 1477177582 | Laura Michelle Rossin | Nurse Practitioner | 736 Sequoia Way, Virginia Beach, VA 23451-4471 | 2020-06-04 |
| 1356964373 | A New Day Healthcare | Nurse Practitioner | 1604 Hilltop West Ctr Ste 215, Virginia Beach, VA 23451-6196 | 2020-05-26 |
| 1710508049 | Christina Barnett | Nurse Practitioner | 1413 Dermott Ave, Virginia Beach, VA 23455-4119 | 2020-04-28 |
| 1336769934 | Leah Rose | Nurse Practitioner | 4477 Pissarro Dr, Virginia Beach, VA 23456-5468 | 2020-04-23 |
| 1174151310 | Angela Fleetwood | Nurse Practitioner | 5712 Bannock Rd, Virginia Beach, VA 23462-3904 | 2020-04-01 |
| 1508498676 | John Charles Rowe Jr. | Nurse Practitioner | 4812 Station House Ln, Virginia Beach, VA 23455-1935 | 2020-02-06 |
| 1356997613 | Alfreda Curtis | Nurse Practitioner | 1527 Brendle Ct, Virginia Beach, VA 23464-6761 | 2019-08-13 |
| Find all providers in VIRGINIA BEACH | ||||
| City | VIRGINIA BEACH |
| Zip Code | 23456 |
Please comment or provide details below to improve the information on KELLY GRAHAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.