=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114458155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KW PERSONNEL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2017
-----------------------------------------------------
Last Update Date | 03/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6470 ROGERS RD
-----------------------------------------------------
City | ROLESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27571-9423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-632-5259
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 132
-----------------------------------------------------
City | ROLESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27571-0132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-632-5259
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTANT / OWNER
-----------------------------------------------------
Name | MS. KURTISHA FAYE WHEELESS
-----------------------------------------------------
Credential | AA, NA1
-----------------------------------------------------
Telephone | 919-632-5259
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------