Provider Demographics
NPI:1861164907
Name:GRAHAM, KIRBY LEE (PA-C)
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:LEE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17579-1012
Mailing Address - Country:US
Mailing Address - Phone:717-682-3012
Mailing Address - Fax:
Practice Address - Street 1:5360 LINCOLN HWY STE 15
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9461
Practice Address - Country:US
Practice Address - Phone:717-442-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062823363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical