MEDICARE: KIANA PAIGE BOOKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497350748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIANA PAIGE BOOKER

Provider Business Mailing Address
First Line	:	114 JOANN DR
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-1625
Country	:	US
Telephone Number	:	859-638-6041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2216 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1898
Country	:	US
Telephone Number	:	513-684-7965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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Directions to “ KIANA PAIGE BOOKER ” Practice Location

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