Provider Demographics
NPI:1245200971
Name:GRAVES, KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-0668
Mailing Address - Country:US
Mailing Address - Phone:479-754-8384
Mailing Address - Fax:479-754-7141
Practice Address - Street 1:601 W MCKENNON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3523
Practice Address - Country:US
Practice Address - Phone:479-754-8384
Practice Address - Fax:479-754-7141
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5306124OtherAETNA INSURANCE COMPANY
AR020407900OtherBLACK LUNG PROGRAM
AR0790780001OtherPALMETTO GBA
AR401067OtherHEALTH LINK
AR0062731OtherUMWA H&R FUNDS
AR2124296OtherUNITED HEALTHCARE
AR13692000000OtherQUALCHOICE
AR51967OtherBLUECROSSBLUESHIELD ARK
AR112436001Medicaid
AR080078696OtherRAILROAD MEDICARE/PALMETT
ARXX12984OtherHEALTH PLUS OF MICHIGAN
AR401067OtherHEALTH LINK
ARB90236Medicare UPIN