MEDICARE: KELLY ANN GRAHAM

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	376K00000X	Nurse's Aide		OH

General Provider Information

NPI Number	:	1245186600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN GRAHAM

Provider Business Mailing Address
First Line	:	1240 PARKMAN RD NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2469
Country	:	US
Telephone Number	:	330-646-7144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 PARKMAN RD NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2469
Country	:	US
Telephone Number	:	330-646-7144
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ KELLY ANN GRAHAM ” Practice Location

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