Active NPI
Karen A Graham, CPWAF
- Clinical Psychologist
- Paducah, KY
National Provider Identifier
1679636757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 100317
- Practice address
- 425 Broadway St
Paducah, KY 42001-0713 - Phone
- (270) 442-7121
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 100317 | KY | Primary |
Addresses
Primary practice location
425 Broadway St
Paducah, KY 42001-0713
Mailing address
425 Broadway St
Paducah, KY 42001-0713
Phone (270) 442-7121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| KY-164 | Other | KY | PSYCHOLOGY AUTONOMOUS FUN |
Other names 1
- Karen A Granger
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626307200000",
"number": "1679636757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 BROADWAY ST",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420010713",
"telephone_number": "270-442-7121",
"fax_number": "270-443-9692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 BROADWAY ST",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420010713",
"telephone_number": "270-442-7121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "KAREN",
"middle_name": "A",
"credential": "CPWAF",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2021-07-15",
"certification_date": "2021-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "100317",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY AUTONOMOUS FUN",
"identifier": "KY-164",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KAREN",
"last_name": "GRANGER",
"middle_name": "A",
"credential": "CPWAF",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.