Provider Demographics
NPI:1427501774
Name:GRAVES, KAYLA (RD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 W 76TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3061
Mailing Address - Country:US
Mailing Address - Phone:573-576-2723
Mailing Address - Fax:
Practice Address - Street 1:6736 W 76TH ST
Practice Address - Street 2:APT A
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3061
Practice Address - Country:US
Practice Address - Phone:573-576-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered