MEDICARE: MS. KIARRA RENEA GAINES RN, EMT-P

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	146L00000X	Paramedic	1878908	MI
2	163W00000X	Registered Nurse	4704360624	MI
3	163WE0003X	Emergency Registered Nurse	4704360624	MI

General Provider Information

NPI Number	:	1518534031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIARRA RENEA GAINES RN, EMT-P

Provider Business Mailing Address
First Line	:	5150 RUDGATE CIR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 RUDGATE CIR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2077
Country	:	US
Telephone Number	:	248-563-1592
Fax Number	:

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	06/21/2022

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