MEDICARE: KALIYAH ARETHA RUSSELL CNA

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	376K00000X	Nurse's Aide	CNA468704	FL
2	374U00000X	Home Health Aide	CNA468704	FL

General Provider Information

NPI Number	:	1871421289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALIYAH ARETHA RUSSELL CNA

Provider Business Mailing Address
First Line	:	3770 TOLEDO RD APT 172
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-3353
Country	:	US
Telephone Number	:	904-673-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	3770 TOLEDO RD APT 172
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-3353
Country	:	US
Telephone Number	:	904-673-0064
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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