Provider Demographics
NPI:1740173905
Name:GRAVES, HEATHER R
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:R
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 COUNTY HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32567-4523
Mailing Address - Country:US
Mailing Address - Phone:850-520-1337
Mailing Address - Fax:
Practice Address - Street 1:2842 COUNTY HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:FL
Practice Address - Zip Code:32567-4523
Practice Address - Country:US
Practice Address - Phone:850-520-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA227146251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health