Provider Demographics
NPI:1063656718
Name:GRAHAM, KALMA ROSE (AP)
Entity Type:Individual
Prefix:MISS
First Name:KALMA
Middle Name:ROSE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AP
Other - Prefix:MISS
Other - First Name:KALMA
Other - Middle Name:ROSE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:490 WOODED CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6546
Mailing Address - Country:US
Mailing Address - Phone:321-298-6182
Mailing Address - Fax:
Practice Address - Street 1:490 WOODED CROSSING CIR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6546
Practice Address - Country:US
Practice Address - Phone:321-298-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2652171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist