Provider Demographics
NPI:1578163366
Name:GRAVES, KAMALA DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:KAMALA
Middle Name:DAWN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KAMALA
Other - Middle Name:DAWN KUPPLER
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:6310 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-8707
Mailing Address - Country:US
Mailing Address - Phone:812-923-6306
Mailing Address - Fax:
Practice Address - Street 1:2363 HIGHWAY 135 NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2153
Practice Address - Country:US
Practice Address - Phone:812-738-1294
Practice Address - Fax:812-738-1660
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017287A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer