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General NPI Number Information
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NPI Number | 1457002818
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Entity Type | Organization
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Legal Business Name | K.O. HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 11747 JEFFERSON AVE STE 6C
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1998
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Country | US
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Telephone | 757-870-7838
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Fax |
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Provider Business Mailing Address
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Address Line | 11747 JEFFERSON AVE STE 6C
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1998
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Country | US
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Telephone | 757-870-7838
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KELLY OWENS
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Credential | NP
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Telephone | 757-870-6803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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