MEDICARE: KAJUANA GIVENS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	172A00000X	Driver
3	174400000X	Specialist
4	342000000X	Transportation Network Company
5	343800000X	Secured Medical Transport (VAN)
6	347C00000X	Private Vehicle
7	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639957533	OTHER		MEDITRANS XPRESS

General Provider Information

NPI Number	:	1518646603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAJUANA GIVENS

Provider Business Mailing Address
First Line	:	7301 TRIMBLE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4639
Country	:	US
Telephone Number	:	219-359-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 TRIMBLE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4639
Country	:	US
Telephone Number	:	219-359-0796
Fax Number	:

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

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	09/29/2023

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Directions to “ KAJUANA GIVENS ” Practice Location

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