Healthcare Provider Details

I. General information

NPI: 1841137197
Provider Name (Legal Business Name): KACEY XIMINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10176 BALTIMORE NATIONAL PIKE STE 206
ELLICOTT CITY MD
21042-3652
US

IV. Provider business mailing address

10176 BALTIMORE NATIONAL PIKE STE 206
ELLICOTT CITY MD
21042-3652
US

V. Phone/Fax

Practice location:
  • Phone: 410-720-9921
  • Fax: 443-458-6093
Mailing address:
  • Phone: 410-720-9921
  • Fax: 443-458-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: