Healthcare Provider Details

I. General information

NPI: 1467700849
Provider Name (Legal Business Name): KIMBERLY B GRAVES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH DUNLAP
MEMPHIS TN
38103-2800
US

IV. Provider business mailing address

PO BOX 5099
MEMPHIS TN
38103-5099
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6060
  • Fax:
Mailing address:
  • Phone: 901-287-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number162269
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: