Healthcare Provider Details

I. General information

NPI: 1487932091
Provider Name (Legal Business Name): KYAKBA THERAPEUTIC HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2011
Last Update Date: 07/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15522 BAILEYS LN
SILVER SPRING MD
20906-1343
US

IV. Provider business mailing address

15522 BAILEYS LN
SILVER SPRING MD
20906-1343
US

V. Phone/Fax

Practice location:
  • Phone: 301-525-3933
  • Fax: 240-491-5994
Mailing address:
  • Phone: 301-525-3933
  • Fax: 240-491-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR181699
License Number StateMD

VIII. Authorized Official

Name: CLAUDIA WARREN-TAYLOR
Title or Position: CEO
Credential: FNP-BC
Phone: 301-525-3933