Kristen Graham, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

235852 Issued in AZ

Practice address

13575 W Indian School Rd Ste 200
Litchfield Park, AZ 85340-4906

Phone

(623) 512-4310

Fax

(623) 512-4311

NPI assigned

Oct 25, 2019

Last updated

May 10, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alta Dermatology Group LTDGroup PAC ID 4587656723, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Alta Dermatology Group LTD

  • Dermatology Physician
  • Mesa, AZ
  • NPI 1780801506
  Medicare reassignment Care Compare group NPD
• Richard Lee Averitte Jr PLLC

  dba Affiliated Dermatology

  • Dermatology Physician
  • Scottsdale, AZ
  • NPI 1407804115
  Medicare reassignment NPD
• Integrated Dermatology of Mesa PLLC

  • Dermatology Physician
  • Mesa, AZ
  • NPI 1922378850
  NPD
• Privia Medical Group Arizona, LLC

  • Neurology Physician
  • Phoenix, AZ
  • NPI 1245876705
  NPD (past)
• Richard Lee Averitte Jr PLLC

  dba Affiliated Dermatology

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1609291848
  NPD (past)

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1588207138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6922 W KRISTAL WAY",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085772",
            "telephone_number": "602-291-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13575 W INDIAN SCHOOL RD STE 200",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853404906",
            "telephone_number": "623-512-4310",
            "fax_number": "623-512-4311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6922 W Kristal Way",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853085772",
            "country_code": "US",
            "telephone_number": "602-291-2612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KRISTEN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-25",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "235852",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Litchfield Park, AZ
• Providers in Litchfield Park, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.