Provider Demographics
NPI:1003570573
Name:GRAVES, KAYLA (LPN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33625 STATE ROUTE 683
Mailing Address - Street 2:
Mailing Address - City:MC ARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651-8655
Mailing Address - Country:US
Mailing Address - Phone:740-418-9886
Mailing Address - Fax:
Practice Address - Street 1:33625 STATE ROUTE 683
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-8655
Practice Address - Country:US
Practice Address - Phone:740-418-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172598164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse