Healthcare Provider Details

I. General information

NPI: 1083577696
Provider Name (Legal Business Name): KWOME WHIRLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 NANNIE HELEN BURROUGHS AVE NE APT 503
WASHINGTON DC
20019-3772
US

IV. Provider business mailing address

4800 NANNIE HELEN BURROUGHS AVE NE APT 506
WASHINGTON DC
20019-3772
US

V. Phone/Fax

Practice location:
  • Phone: 202-560-4091
  • Fax:
Mailing address:
  • Phone: 202-843-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: