Provider Demographics
NPI:1053506899
Name:GRAHAM, DAVID (RN, MSN, NP-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240132
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0132
Mailing Address - Country:US
Mailing Address - Phone:443-902-8816
Mailing Address - Fax:334-323-7148
Practice Address - Street 1:5911 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1940
Practice Address - Country:US
Practice Address - Phone:443-902-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129274363LG0600X, 363L00000X
FLAPRN11001771363LG0600X
MDT20071316163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse