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General NPI Number Information
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NPI Number | 1144747403
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Entity Type | Individual
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Provider Name | KIAH LYNN CARDENAS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 218 HOWLE AVE
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City | CHARLESTON
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State | SC
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Zip | 29412-2449
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Country | US
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Telephone | 833-225-3558
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Fax |
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Provider Business Mailing Address
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Address Line | 1662 S WOLVERINE WAY
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City | WASHINGTON
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State | UT
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Zip | 84780-3638
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Country | US
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Telephone | 530-613-4662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 54827
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 54827
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 54827
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13676616-1206
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License Number State | UT
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