Provider Demographics
NPI:1326313008
Name:GRAVES, KENYETTA D (CRNA)
Entity Type:Individual
Prefix:
First Name:KENYETTA
Middle Name:D
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KENYETTA
Other - Middle Name:D
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-1447
Mailing Address - Fax:310-423-0987
Practice Address - Street 1:8700 BEVERLY BLVD # SB290
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-1447
Practice Address - Fax:310-423-0987
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009328163W00000X
IL209.009328367500000X
CA95002032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse