Provider Demographics
NPI:1033919634
Name:GRAHAM, KALLEE R
Entity type:Individual
Prefix:
First Name:KALLEE
Middle Name:R
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-2242
Mailing Address - Country:US
Mailing Address - Phone:402-613-8333
Mailing Address - Fax:
Practice Address - Street 1:2312 AVENUE E
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-2242
Practice Address - Country:US
Practice Address - Phone:402-613-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant