Active NPI
Jean Ann Graham
- Nutrition Support Pharmacist
- Austin, TX
National Provider Identifier
1457844656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Support Pharmacist
- License
- 21955
- Practice address
- 2503 Saratoga Dr
Austin, TX 78733-1240 - Phone
- (512) 299-1500
- NPI assigned
- Jun 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Home Health Aide | 374U00000X | |||
| Nutrition Support Pharmacist | 1835N1003X | 21955 | TX | Primary |
Addresses
Primary practice location
2503 Saratoga Dr
Austin, TX 78733-1240
Mailing address
PO Box 340744
Austin, TX 78734-0013
Phone (512) 299-1500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21955 | TX | MD | Nutrition Support Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528761600000",
"number": "1457844656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 340744",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787340013",
"telephone_number": "512-299-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2503 SARATOGA DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787331240",
"telephone_number": "512-299-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "JEAN",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-12",
"last_updated": "2018-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": false
},
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "TX",
"license": "21955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.