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General NPI Number Information
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NPI Number | 1487932091
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Entity Type | Organization
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Legal Business Name | KYAKBA THERAPEUTIC HEALTH SERVICES LLC
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Dates
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Enumeration Date | 07/31/2011
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Last Update Date | 07/31/2011
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Provider Practice Location Address
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Address Line | 15522 BAILEYS LN
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City | SILVER SPRING
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State | MD
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Zip | 20906-1343
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Country | US
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Telephone | 301-525-3933
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Fax | 240-491-5994
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Provider Business Mailing Address
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Address Line | 15522 BAILEYS LN
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City | SILVER SPRING
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State | MD
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Zip | 20906-1343
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Country | US
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Telephone | 301-525-3933
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Fax | 240-491-5994
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Authorized Official
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Title or Position | CEO
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Name | CLAUDIA WARREN-TAYLOR
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Credential | FNP-BC
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Telephone | 301-525-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R181699
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License Number State | MD
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