EBONY MONTEZZ GRAHAM – Nurse Practitioner, NPI 1336629518
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,261 NURSE PRACTITIONER in WA
Provider Addresses for EBONY MONTEZZ GRAHAM
300, North Washington Street, Medical Lake, Spokane County, Washington, 99022, United States
SPOKANE, WA 992010254
Phone: (509) 444-8888
Fax: (509) 444-7806
Type: Mailing
611 N IRON BRIDGE WAY
SPOKANE, WA 992024932
Phone: (509) 444-8888
Type: Mailing
15812 E INDIANA AVE STE 101
SPOKANE VALLEY, WA 992161875
Phone: (509) 444-8200
Fax: (509) 444-7806
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-12-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20181226001020 | I | Nurse Practitioner | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 99201)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| Nurse Practitioner | WA | |
| Nurse Practitioner | WA | |
| Certified Nurse Midwife (Cnm) | WA | |
| Certified Nurse Midwife (Cnm) | WA | |
| Physician Assistant | WA | |
| - | WA | |
| Nurse Practitioner | WA | |
| - | WA | |
| Mental Health Counselor | WA |
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