Healthcare Provider Details

I. General information

NPI: 1487331674
Provider Name (Legal Business Name): KYONNA MICHELLA DAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYONNA MICHELLA BROWN MCFARLANE

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PARK AVE STE 211
CRANSTON RI
02910-3227
US

IV. Provider business mailing address

75 PUTNAM PIKE APT 6
JOHNSTON RI
02919-2054
US

V. Phone/Fax

Practice location:
  • Phone: 401-318-2518
  • Fax:
Mailing address:
  • Phone: 857-300-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: