Dorothy Luanne Gravely
Individual provider Active NPI Nurse's Aide · South Shore, KY
NPI 1023699642 · NPPES record last updated Oct 15, 2025
Key facts
- NPI
- 1023699642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse's Aide 376K00000X
- License
- 400367260604 (OH)
- Practice address
- 1323 Blackbird Rd
South Shore, KY 41175-7018 - Phone
- (606) 923-2873
- NPI assigned
- Apr 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 400367260604 | OH | MD | Nurse's Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | |||
| Nurse's Aide |
376K00000X | 400367260604 | OH | Yes |
Addresses
Primary practice location
1323 Blackbird Rd
South Shore, KY 41175-7018
Mailing address
1323 Blackbird Rd
South Shore, KY 41175-7018
Phone (606) 923-2873
Other providers in South Shore, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.