Individual
KEISHA GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3895 GEORGE ANDERSON RD, SPRINGDALE, AR 72764-8251
(479) 521-1532
Mailing address
16240 WANN RD, SULPHUR SPRINGS, AR 72768-9036
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L060680
AR
Other
Enumeration date
12/30/2020
Last updated
12/30/2020
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