Staci Marie Graber, APN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

A001929 Issued in AR

Practice address

5203 Willow Creek Dr. Ste 203
Springdale, AR 72762

Phone

(479) 757-8001

Fax

(479) 750-0571

NPI assigned

May 17, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Saveritt Pediatrics PLLC

  • Pediatric Adolescent Medicine Physician
  • Springdale, AR
  • NPI 1689182412
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1154538247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 WILLOW CREEK DR. STE 203",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "72762",
            "telephone_number": "479-575-9359",
            "fax_number": "479-575-9415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5203 WILLOW CREEK DR. STE 203",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "72762",
            "telephone_number": "479-757-8001",
            "fax_number": "479-750-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRABER",
        "first_name": "STACI",
        "middle_name": "MARIE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AR",
            "license": "A001929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167760758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Theresa Gordon, NP
• Steven Corbin Gorgas, DPT
• Megan Rose Gorham, PA-C
• Bailey Ann Gotte
• Bailey Gould
• Grace Family Medical, LLC
• Grace Haven Ministries
• Maria T Grace, LCSW
• Sally L Grace, A.P.N.
• Caisa Gracie, LMSW

• Pediatric Nurse Practitioner in Springdale, AR
• Providers in Springdale, AR by specialty
• Pediatric Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.