Provider Demographics
NPI:1316175771
Name:GRAHAM, KEVIN FRANKLIN (HHPBC-HIS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:FRANKLIN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:HHPBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801-B BROADWAY
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956
Mailing Address - Country:US
Mailing Address - Phone:479-471-6807
Mailing Address - Fax:479-471-6879
Practice Address - Street 1:801-B BROADWAY
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956
Practice Address - Country:US
Practice Address - Phone:479-471-6807
Practice Address - Fax:479-471-6879
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#591237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist