Marietta Graham-Lopez, RN, CS FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

083458 Issued in MO

Practice address

900 E Cherry St
Troy, MO 63379-1429

Phone

(636) 528-8585

Fax

(636) 528-8430

NPI assigned

Dec 15, 2005

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, Registered Nurse

State licenses

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433289600000",
    "number": "1457337149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 E CHERRY ST",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633791429",
            "telephone_number": "636-528-8585",
            "fax_number": "636-528-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E CHERRY ST",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633791429",
            "telephone_number": "636-528-8585",
            "fax_number": "636-528-8430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM-LOPEZ",
        "first_name": "MARIETTA",
        "credential": "RN, CS FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-15",
        "last_updated": "2015-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "083458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424021202",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Lynn Goodman, LMSW
• Kelly Gowen, RN
• Jessica Graf, P.T.
• Aaron Grah
• Samantha L Graham-Douglas, LPC
• Crystal Leigh Graver
• Greatsmiles, Inc.
• Kirstynn Greer, PLPC
• Lori Alice Griffith, P.T.
• Kimberly R. Gudehus, PTA

• Nurse Practitioner in Troy, MO
• Providers in Troy, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.