Healthcare Provider Details

I. General information

NPI: 1841149887
Provider Name (Legal Business Name): KIERRA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TERRANCE
GLENDALE CA
91206
US

IV. Provider business mailing address

215 E REGENT ST APT 333
INGLEWOOD CA
90301-1827
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax:
Mailing address:
  • Phone: 804-424-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95204936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: