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General NPI Number Information
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NPI Number | 1164909586
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Entity Type | Organization
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Legal Business Name | 4K TRESSES
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 1220 EXECUTIVE BLVD STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 404-860-2114
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Fax | 757-482-4840
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Provider Business Mailing Address
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Address Line | 1008 KENDALE CIR
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City | CHESAPEAKE
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State | VA
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Zip | 23322-6872
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Country | US
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Telephone | 404-860-2114
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Fax | 757-482-4840
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Authorized Official
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Title or Position | CEO
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Name | NYKOI R POTTS-SLOWE
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Credential |
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Telephone | 404-860-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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