Provider Demographics
NPI:1245788355
Name:GRAVES, KENDRA A
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:A
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 CARTIER DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6312
Mailing Address - Country:US
Mailing Address - Phone:504-214-3575
Mailing Address - Fax:
Practice Address - Street 1:616 BETSY ROSS CT
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2374
Practice Address - Country:US
Practice Address - Phone:504-450-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator