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General NPI Number Information
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NPI Number | 1225883945
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Entity Type | Organization
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Legal Business Name | KIANGO GROUP, LLC
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 2129 FM 2920 RD STE 171
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City | SPRING
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State | TX
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Zip | 77388-3671
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Country | US
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Telephone | 612-390-0241
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Fax |
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Provider Business Mailing Address
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Address Line | 2129 FM 2920 RD STE 171
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City | SPRING
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State | TX
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Zip | 77388-3671
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Country | US
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Telephone | 612-390-0241
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BONIFACE ANYIENI
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Credential |
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Telephone | 612-390-0241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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