Healthcare Provider Details
I. General information
NPI: 1710679758
Provider Name (Legal Business Name): NUKEYSHA LAFAY SILLMON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
304 DABNEY ST
TALLADEGA AL
35160-2925
US
IV. Provider business mailing address
304 DABNEY ST
TALLADEGA AL
35160-2925
US
V. Phone/Fax
- Phone: 904-402-3706
- Fax:
- Phone: 904-402-3706
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251F00000X |
| Taxonomy | Home Infusion Agency |
| License Number | 1-147471 |
| License Number State | AL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251J00000X |
| Taxonomy | Nursing Care Agency |
| License Number | 1-147471 |
| License Number State | AL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332U00000X |
| Taxonomy | Home Delivered Meals |
| License Number | 1-147471 |
| License Number State | AL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC2100X |
| Taxonomy | Continence Care Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0600X |
| Taxonomy | Infection Control Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0200X |
| Taxonomy | Pediatric Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 1-147471 |
| License Number State | AL |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | 1-147471 |
| License Number State | AL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
