Provider Demographics
NPI:1164765582
Name:GRAVES, KEVIN ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-2309
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:120 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:KY
Practice Address - Zip Code:42024-9579
Practice Address - Country:US
Practice Address - Phone:270-334-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2853207Q00000X
KY03661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100284330Medicaid
KY7100284330Medicaid