Healthcare Provider Details

I. General information

NPI: 1871363861
Provider Name (Legal Business Name): ISATU YAKATIE KALOKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 07/29/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

IV. Provider business mailing address

5680 KING CENTRE DR STE 600
ALEXANDRIA VA
22315-5755
US

V. Phone/Fax

Practice location:
  • Phone: 571-388-0172
  • Fax: 571-771-1076
Mailing address:
  • Phone: 571-388-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401188821
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1401188821
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: