1376165530 NPI number — DR. KIRSTEN LEIGH GRAHAM PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376165530 NPI number — DR. KIRSTEN LEIGH GRAHAM PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHAM
Provider First Name:
KIRSTEN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376165530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 W UNIVERSITY BLVDGENERAL CLASSROOMS 308-O
Provider Second Line Business Mailing Address:
GENERAL CLASSROOMS 308-O
Provider Business Mailing Address City Name:
CEDAR CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-865-8446
Provider Business Mailing Address Fax Number:
435-865-8289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 W UNIVERSITY BLVDGENERAL CLASSROOMS 308-O
Provider Second Line Business Practice Location Address:
GENERAL CLASSROOMS 308-O
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-277-0285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  11486546-2501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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