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General NPI Number Information
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NPI Number | 1093511339
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Entity Type | Organization
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Legal Business Name | KST BEAUTY & BODY CARE
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1233 MALL DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4737
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Country | US
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Telephone | 917-856-6295
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 MALL DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDENTIALING DIRECTOR
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Name | NATACHA WILLIAMS
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Credential |
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Telephone | 757-608-9255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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