Provider Demographics
NPI:1649062571
Name:GRISELL, KARA
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:GRISELL
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 1:607 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1057
Mailing Address - Country:US
Mailing Address - Phone:606-620-6761
Mailing Address - Fax:
Practice Address - Street 1:2127 E VICTORY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3917
Practice Address - Country:US
Practice Address - Phone:912-443-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program