Healthcare Provider Details

I. General information

NPI: 1275210478
Provider Name (Legal Business Name): KIMBERLY MICHELLE GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MICHELLE KENNEDY NP

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD STE 14
LAS VEGAS NV
89102-1930
US

IV. Provider business mailing address

224 SHASTA MEADOWS ST
HENDERSON NV
89012-5342
US

V. Phone/Fax

Practice location:
  • Phone: 855-871-0841
  • Fax:
Mailing address:
  • Phone: 775-842-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number870340
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: