Healthcare Provider Details

I. General information

NPI: 1972065696
Provider Name (Legal Business Name): MS. KURTISA KY'LEAF WILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 STANTON TER SE
WASHINGTON DC
20020-2823
US

IV. Provider business mailing address

2319 HARTFORD ST SE APT 302
WASHINGTON DC
20020-7920
US

V. Phone/Fax

Practice location:
  • Phone: 202-907-5698
  • Fax:
Mailing address:
  • Phone: 202-573-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: