Lisa Mae Diane Graveline, PMHNP-BC, APRN-RNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RNP265685 Issued in AZ

Practice address

3274 Bob Dr
Prescott Valley, AZ 86314-8640

Phone

(928) 203-5414

Fax

(866) 984-3891

NPI assigned

Oct 15, 2021

Last updated

Mar 13, 2024By 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 1

Addresses

Other identifiers 1

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spectrum Healthcare Group IncGroup PAC ID 3072411388, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisamae.graveline.p1@direct.spectrumhg.nextgenshare.com

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.

• Spectrum Healthcare Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cottonwood, AZ
  • NPI 1487635389

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Spectrum Healthcare Group, Inc

  • Primary Care Clinic/Center
  • Cottonwood, AZ
  • NPI 1376840918
  NPD
• Spectrum Healthcare Group, Inc

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1912614413

  Psychiatric/Mental Health

  NPD
• Spectrum Healthcare Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tucson, AZ
  • NPI 1831811850

  Psychiatric/Mental Health

  NPD

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

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1801559984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3274 BOB DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148640",
            "telephone_number": "928-203-5414",
            "fax_number": "866-984-3891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3274 BOB DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148640",
            "telephone_number": "928-203-5414",
            "fax_number": "866-984-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVELINE",
        "first_name": "LISA MAE",
        "middle_name": "DIANE",
        "credential": "PMHNP-BC, APRN-RNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-15",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RNP265685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "RNP-265685",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angie J Graham, PSY.D.
• Granite Mountain Behavioral Health Care of Az, LLC
• Granite Orthopaedics, PLLC
• Granville Assisted Living - Paradise Retreat LLC
• Michael C Grato
• Loleita Leanora Green-Reid, APRN-FNP
• Brooke A Green, DNP-C
• Tanya Renae Green, MT
• Gary Howard Greene, O.D.
• Virginia I Greene, FNP

• Psychiatric/Mental Health Nurse Practitioner in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.