MEDICARE: KRISTA GRADDY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	27169-M	AR

General Provider Information

NPI Number	:	1205497468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA GRADDY LMSW

Provider Business Mailing Address
First Line	:	PO BOX 176
Second Line	:
City	:	CHEROKEE VILLAGE
State	:	AR
Zip	:	72525-0176
Country	:	US
Telephone Number	:	870-856-3337
Fax Number	:	870-856-3334

Provider Business Practice Location Address
First Line	:	1560 W BEEBE CAPPS EXPY STE B
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-5176
Country	:	US
Telephone Number	:	501-451-5891
Fax Number	:	501-663-1839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	04/23/2025

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Directions to “ KRISTA GRADDY LMSW” Practice Location

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