Tyra Nicole Graves, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202008424 Issued in VA

Practice address

112 N Constitution Dr
Yorktown, VA 23692-2792

Phone

(757) 890-0675

NPI assigned

Mar 7, 2021

Last updated

Mar 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Functional Pathways Preferred of Tennessee LLC

  • Physical Therapist
  • Knoxville, TN
  • NPI 1841561446

  Speech-Language Pathologist, VA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615075200000",
    "number": "1023603586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1257 PETWORTH LN",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236087741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N CONSTITUTION DR",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236922792",
            "telephone_number": "757-890-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "TYRA",
        "middle_name": "NICOLE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-07",
        "last_updated": "2021-03-07",
        "certification_date": "2021-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202008424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Jeanne Giles, LCSW
• Patricia Goodwin
• Diana M Gordon, FNP
• Niyah Gransbury, MT-BC
• Taryn Raye Grasty
• Lee Green Sr.
• Nicole Elaine Grey
• Carolyn Griffith, LPC
• Krista Marie Grimmett, PA-C
• Yu Guan, M.D.

• Speech-Language Pathologist in Yorktown, VA
• Providers in Yorktown, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.