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General NPI Number Information
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NPI Number | 1568394443
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Entity Type | Individual
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Provider Name | KYRA JAE GRAHAM
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Gender | Female
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 6100 S LOUISE AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57108-6021
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Country | US
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Telephone | 605-504-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 511 E 4TH ST 1/2
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City | DELL RAPIDS
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State | SD
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Zip | 57022-2009
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Country | US
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Telephone | 605-261-0576
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000060204
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License Number State | SD
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