MEDICARE: GRACEE KEITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst		NC

General Provider Information

NPI Number	:	1336088228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACEE KEITH

Provider Business Mailing Address
First Line	:	1223 5TH ST
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-7107
Country	:	US
Telephone Number	:	828-303-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	6634 OLD STATESVILLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6768
Country	:	US
Telephone Number	:	704-251-4898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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Directions to “ GRACEE KEITH ” Practice Location

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