1912335100 NPI number — MRS. KIMBERLY H GRAW APRN, BC, FNP

Table of content: MRS. KIMBERLY H GRAW APRN, BC, FNP (NPI 1912335100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912335100 NPI number — MRS. KIMBERLY H GRAW APRN, BC, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAW
Provider First Name:
KIMBERLY
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
HOPE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912335100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 N GROSS ROAD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KINGSLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-729-2795
Provider Business Mailing Address Fax Number:
912-729-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 N GROSS ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KINGSLAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-729-2795
Provider Business Practice Location Address Fax Number:
912-729-4117
Provider Enumeration Date:
10/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN191658 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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