Provider Demographics
NPI:1386512283
Name:GRAGG, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GRAGG
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 1:132 MEGKAT DR
Mailing Address - Street 2:
Mailing Address - City:PENCE SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24962-5500
Mailing Address - Country:US
Mailing Address - Phone:304-667-9004
Mailing Address - Fax:
Practice Address - Street 1:132 MEGKAT DR
Practice Address - Street 2:
Practice Address - City:PENCE SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24962-5500
Practice Address - Country:US
Practice Address - Phone:304-667-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114266163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health