Healthcare Provider Details

I. General information

NPI: 1649877911
Provider Name (Legal Business Name): KIYAH NKAAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 HEWITT AVE
SILVER SPRING MD
20906-4971
US

IV. Provider business mailing address

3207 HEWITT AVE
SILVER SPRING MD
20906-4971
US

V. Phone/Fax

Practice location:
  • Phone: 240-722-8096
  • Fax: 240-722-8096
Mailing address:
  • Phone: 240-722-8096
  • Fax: 240-722-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00171924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: