Healthcare Provider Details

I. General information

NPI: 1679921779
Provider Name (Legal Business Name): KELSEY R GRAVEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 08/12/2025
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LAKE BOONE TR SUITE 100
RALEIGH NC
27607
US

IV. Provider business mailing address

4600 LAKE BOONE TR SUITE 100
RALEIGH NC
27607
US

V. Phone/Fax

Practice location:
  • Phone: 197-871-3749
  • Fax: 919-571-8135
Mailing address:
  • Phone: 919-787-1374
  • Fax: 919-571-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number202101872
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: