Provider Demographics
NPI:1558666180
Name:GRAHAM, KIM B (RCP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-7948
Mailing Address - Country:US
Mailing Address - Phone:919-963-6906
Mailing Address - Fax:
Practice Address - Street 1:207 S JOYLAND AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-3326
Practice Address - Country:US
Practice Address - Phone:919-957-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-1897227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified