Provider Demographics
NPI:1205497468
Name:GRADDY, KRISTA (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GRADDY
Suffix:
Gender:
Credentials:LMSW
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 176
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72525-0176
Mailing Address - Country:US
Mailing Address - Phone:870-856-3337
Mailing Address - Fax:870-856-3334
Practice Address - Street 1:1560 W BEEBE CAPPS EXPY STE B
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5176
Practice Address - Country:US
Practice Address - Phone:501-451-5891
Practice Address - Fax:501-663-1839
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27169-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker