Provider Demographics
NPI:1871143396
Name:GRAVES, KACIE J (FNP)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:J
Last Name:GRAVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 OLD NORCROSS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3386
Mailing Address - Country:US
Mailing Address - Phone:770-962-4300
Mailing Address - Fax:
Practice Address - Street 1:1505 NORTHSIDE BLVD STE 4600
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7658
Practice Address - Country:US
Practice Address - Phone:770-205-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily