MEDICARE: KINGDOM ADMINISTRATIVE AMBASSADORS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1780533901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM ADMINISTRATIVE AMBASSADORS

Provider Business Mailing Address
First Line	:	9800 AIRLINE HWY STE 233
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8195
Country	:	US
Telephone Number	:	225-364-9097
Fax Number	:	405-937-3549

Provider Business Practice Location Address
First Line	:	9800 AIRLINE HWY STE 233
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8195
Country	:	US
Telephone Number	:	225-364-9097
Fax Number	:	405-937-3549

Authorized Official
Title or Position	:	CHIEF ADMINISTRATOR
Name	:	MRS. WHITNEY RENEE SMITH
Credential	:
Telephone Number	:	225-364-9097

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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