Provider Demographics
NPI:1548984198
Name:GRAGG, KYLEE MARIE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:MARIE
Last Name:GRAGG
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 1:563 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3307
Mailing Address - Country:US
Mailing Address - Phone:316-207-5010
Mailing Address - Fax:
Practice Address - Street 1:563 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3307
Practice Address - Country:US
Practice Address - Phone:316-207-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services