Individual ProviderDylan GrahamNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3636 Springdale Rd, Cincinnati, OH 45251-1407(513) 639-9900PECOS EnrollmentBased on the most recent information from CMS, provider Dylan Graham is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:47 AM.Profile DetailsProvider ID1508632449Provider TypeIndividualFull NameGraham, DylanCredentialMSN, FNP-CGenderMaleSole ProprietorNoEnumeration Date12/1/2023Last Updated12/1/2023Contact InformationPractice LocationPractice Address3636 Springdale Rd, Cincinnati, OH 45251-1407Phone(513) 639-9900FaxUnlisted FaxMailing LocationMailing Address2620 Elm Hill Pike, Nashville, TN 37214-3100PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseF10230160Ohio