Healthcare Provider Details

I. General information

NPI: 1265369565
Provider Name (Legal Business Name): DEBRA ANN GRAHAM RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9166 SW 60TH COURT RD
OCALA FL
34476-8783
US

IV. Provider business mailing address

1370 TULLAHOMA DR
PRATTVILLE AL
36066-2103
US

V. Phone/Fax

Practice location:
  • Phone: 786-218-8974
  • Fax:
Mailing address:
  • Phone: 786-218-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6716
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND6716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: