Individual
MRS. KIMBERLY FAYE GRAVLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD,LD
Contact information
Practice address
13302 TUCKER LAKE DR., LOUISVILLE, KY 40299-4552
(502) 710-1058
(502) 267-9694
Mailing address
13302 TUCKER LAKE DR., LOUISVILLE, KY 40299-4552
(502) 710-1058
(502) 267-9694
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
KY - 1367
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01938
NUMBER FOR CBIS BILLING
KY
Enumeration date
10/11/2006
Last updated
07/08/2007
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