Healthcare Provider Details

I. General information

NPI: 1205497468
Provider Name (Legal Business Name): KRISTA GRADDY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 W BEEBE CAPPS EXPY STE B
SEARCY AR
72143-5176
US

IV. Provider business mailing address

PO BOX 176
CHEROKEE VILLAGE AR
72525-0176
US

V. Phone/Fax

Practice location:
  • Phone: 501-451-5891
  • Fax: 501-663-1839
Mailing address:
  • Phone: 870-856-3337
  • Fax: 870-856-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27169-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: