Healthcare Provider Details

I. General information

NPI: 1093339152
Provider Name (Legal Business Name): KAILEY ANN GRAYBILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE # 2
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 832-293-3285
  • Fax:
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU5415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: