Healthcare Provider Details

I. General information

NPI: 1912778556
Provider Name (Legal Business Name): KAYCIE NIA HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CEDAR BR
MADISON AL
35756-3987
US

IV. Provider business mailing address

128 CEDAR BR
MADISON AL
35756-3987
US

V. Phone/Fax

Practice location:
  • Phone: 703-380-1602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR244099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: