Manette Elaine Graham, PRESIDENT OF THE LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Practice address

1717 E Cayuga St
Tampa, FL 33610-6025

Phone

(813) 665-5536

NPI assigned

Nov 6, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Mickeycareplus Health Care Services LLC

  • Home Health Agency
  • Tampa, FL
  • NPI 1851055925
  NPD Authorized official

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1588265334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 EAST CAYUGA ST.",
            "address_2": "SAME",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33610",
            "telephone_number": "813-665-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 E CAYUGA ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336106025",
            "telephone_number": "813-665-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MANETTE",
        "middle_name": "ELAINE",
        "name_prefix": "Ms.",
        "credential": "PRESIDENT OF THE LLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-06",
        "last_updated": "2020-11-06",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "elaine.graham47@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Tampa",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1717 E Cayuga St",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336106025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kara Renee Graham, M.S. CCC/SLP
• Kevin Tyler Graham, RN
• Kylee Samantha Graham, PA-C
• Laurel Graham, LMT
• Lecenda V Graham
• Misha Graham
• Nicole Danielle Graham
• Sara May Graham, MD
• Shaquia M Graham
• Steven Douglas Graham, PH.D.

• Home Health Agency in Tampa, FL
• Providers in Tampa, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.