Andrea Margaret Gravley, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R1574690 Issued in MN

Practice address

17705 Hutchins Dr Ste 101
Minnetonka, MN 55345-4102

Phone

(952) 401-8300

Fax

(952) 401-8373

NPI assigned

Aug 28, 2008

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 MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agravley246489@direct.centracare.com
• FHIR API: https://fhir4.healow.com/fhir/r4/DFCFBA/Endpoint/DFCFBA

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

• Childrens Health Care

  • Pediatrics Physician
  • Minneapolis, MN
  • NPI 1932208808
  Medicare reassignment NPD
• Childrens Health Care

  • Hearing Aid Equipment
  • Minneapolis, MN
  • NPI 1790827905
  NPD
• Childrens Health Care

  • Children's Hospital
  • Minneapolis, MN
  • NPI 1881793750
  NPD

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718496000000",
    "number": "1104074434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454102",
            "telephone_number": "952-401-8300",
            "fax_number": "952-401-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454102",
            "telephone_number": "952-401-8300",
            "fax_number": "952-401-8373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVLEY",
        "first_name": "ANDREA",
        "middle_name": "MARGARET",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-28",
        "last_updated": "2024-06-16",
        "certification_date": "2024-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R1574690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand St Paul CVS LLC
• Grand St Paul CVS LLC
• Mia Geraldine Granger
• Amaya Grant
• Jessica Rae Graves, MS, CCC-SLP
• Alexis Gray, MCM, LAC
• Megan Marie Gray, PT, DPT
• Sonja M Green, MD
• Catherine Greene, LMFT
• Natalie Greening

• Pediatric Nurse Practitioner in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.