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General NPI Number Information
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NPI Number | 1114804010
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Entity Type | Individual
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Provider Name | KYLEE LAINE GRAHAM NP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/24/2025
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Provider Practice Location Address
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Address Line | 117 E RAY FINE BLVD
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City | ROLAND
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State | OK
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Zip | 74954-5427
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Country | US
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Telephone | 918-427-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 452972 E 980 RD
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City | VIAN
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State | OK
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Zip | 74962-5280
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Country | US
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Telephone | 918-705-1647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 205132
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License Number State | OK
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