Provider Demographics
NPI:1013220904
Name:GRAHAM, KRISTAL PEARL (CNA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:PEARL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3844 36TH TER S
Mailing Address - Street 2:APT A
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4123
Mailing Address - Country:US
Mailing Address - Phone:727-563-6691
Mailing Address - Fax:
Practice Address - Street 1:3844 36TH TER S
Practice Address - Street 2:APT A
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4123
Practice Address - Country:US
Practice Address - Phone:727-563-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 374U00000X, 376J00000X, 390200000X
FLCNA226231376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program